Provider First Line Business Practice Location Address:
1611 SPENCER HWY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77587-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-925-8797
Provider Business Practice Location Address Fax Number:
832-925-8782
Provider Enumeration Date:
08/10/2006