Individual
SHELBY GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4716 DUVAL RD APT C13, AUSTIN, TX 78727-6852
(432) 528-4488
Mailing address
4716 DUVAL RD APT C13, AUSTIN, TX 78727-6852
(432) 528-4488
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT120935
TX
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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