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Organization
AGELESS ABANDON
Active
Organization
AGELESS ABANDON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY M. GANSKE (CEO)
(512) 459-4400
Entity
Organization
Contact information
Practice address
103 TAMARAC CT, LAKEWAY, TX 78734-4666
(512) 459-4400
Mailing address
1010 W 9TH ST, AUSTIN, TX 78703-4924
(512) 459-4400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G5718
TX
Other
Enumeration date
06/28/2011
Last updated
06/28/2011
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