Provider First Line Business Practice Location Address: 
9525 KATY FRWY
    Provider Second Line Business Practice Location Address: 
STE 200
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77024
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
832-358-5555
    Provider Business Practice Location Address Fax Number: 
713-263-0333
    Provider Enumeration Date: 
03/03/2006