Provider First Line Business Practice Location Address:
5002 S LAKE HOUSTON PKWY
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77049-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-988-7300
Provider Business Practice Location Address Fax Number:
281-988-7302
Provider Enumeration Date:
07/29/2010