Provider First Line Business Practice Location Address: 
6621 FANNIN ST
    Provider Second Line Business Practice Location Address: 
ALLERGY AND IMMUNOLOGY
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77030-2303
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
832-824-1319
    Provider Business Practice Location Address Fax Number: 
832-825-1260
    Provider Enumeration Date: 
10/17/2006