Provider First Line Business Practice Location Address: 
6720 BERTNER AVE. (CHI BAYLOR ST. LUKE'S MEDICAL CENTER
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77030
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-798-4661
    Provider Business Practice Location Address Fax Number: 
713-798-5838
    Provider Enumeration Date: 
04/08/2015