Provider First Line Business Practice Location Address:
6431 FANNIN ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF TEXAS HOUSTON, MSN 2-130B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-323-5311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2013