Provider First Line Business Practice Location Address: 
10245 KEMPWOOD DR
    Provider Second Line Business Practice Location Address: 
# C
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77043-1803
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-690-8585
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/22/2011