Provider First Line Business Practice Location Address:
6621 FANNIN ST A1170
Provider Second Line Business Practice Location Address:
PEDIATRIC HOUSE STAFF OFFICE
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-798-4951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2018