Provider First Line Business Practice Location Address: 
2180 NORTH LOOP W
    Provider Second Line Business Practice Location Address: 
SUITE 450
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77018-8014
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
832-384-1560
    Provider Business Practice Location Address Fax Number: 
832-384-1585
    Provider Enumeration Date: 
10/03/2006