Provider First Line Business Practice Location Address: 
4337 E SAM HOUSTON PKWY N
    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: 
77015-3229
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
832-727-9400
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/23/2014