Provider First Line Business Practice Location Address:
1307 W CLAY ST
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:
77019-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-269-6222
Provider Business Practice Location Address Fax Number:
713-988-3227
Provider Enumeration Date:
06/18/2006