Provider First Line Business Practice Location Address: 
7550 OFFICE CITY DR
    Provider Second Line Business Practice Location Address: 
PHARMACY
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77012-4115
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-842-4319
    Provider Business Practice Location Address Fax Number: 
713-495-3717
    Provider Enumeration Date: 
07/18/2005