Provider First Line Business Practice Location Address: 
1500 CITYWEST BLVD
    Provider Second Line Business Practice Location Address: 
STE. 300
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77042-2300
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-620-4000
    Provider Business Practice Location Address Fax Number: 
713-458-4229
    Provider Enumeration Date: 
03/27/2014