Provider First Line Business Practice Location Address:
4349 MARTIN LUTHER KING BLVD HEALTH 2 BLDG STE 1001E
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:
77204-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-743-9682
Provider Business Practice Location Address Fax Number:
713-743-1049
Provider Enumeration Date:
10/17/2006