Provider First Line Business Practice Location Address: 
921 GESSNER RD
    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: 
77024-2501
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-242-3000
    Provider Business Practice Location Address Fax Number: 
713-827-4096
    Provider Enumeration Date: 
07/12/2006