Provider First Line Business Practice Location Address:
2000 S DAIRY ASHFORD RD
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:
77077-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-736-2223
Provider Business Practice Location Address Fax Number:
800-586-0046
Provider Enumeration Date:
07/30/2026