Provider First Line Business Practice Location Address:
6516 M D ANDERSON BLVD STE 2.059
Provider Second Line Business Practice Location Address:
UNIVERSITY OF TEXAS HOUSTON DENTAL SCHOOL
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-500-4125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2011