Provider First Line Business Practice Location Address:
3611 ENNIS 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:
77004-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-527-4005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2012