Provider First Line Business Practice Location Address:
UT HEALTH SCIENCE CENTER
Provider Second Line Business Practice Location Address:
6431 FANNIN ST
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:
917-873-9436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014