Provider First Line Business Practice Location Address:
1100 W 23RD 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:
77008-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-919-9932
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006