Provider First Line Business Practice Location Address:
1136 DUNBAR 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:
77009-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-213-7336
Provider Business Practice Location Address Fax Number:
713-863-0991
Provider Enumeration Date:
07/16/2007