Provider First Line Business Practice Location Address:
10019 S MAIN ST
Provider Second Line Business Practice Location Address:
MAIN MEDICAL PLAZA, SUITE A-1
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77025-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-668-6000
Provider Business Practice Location Address Fax Number:
713-668-6248
Provider Enumeration Date:
09/25/2005