Provider First Line Business Practice Location Address:
6977 MAIN STREET
Provider Second Line Business Practice Location Address:
SHRINERS HOSPITAL FOR CHILDREN
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-793-3965
Provider Business Practice Location Address Fax Number:
713-793-3978
Provider Enumeration Date:
12/09/2009