Provider First Line Business Practice Location Address:
1919 LA BRANCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-8321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-657-7341
Provider Business Practice Location Address Fax Number:
713-657-7106
Provider Enumeration Date:
06/14/2005