Individual
MR. AUSTIN THOMAS GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPA-C
Contact information
Practice address
1103 WILLIAMS DR STE 1, GEORGETOWN, TX 78628-4109
(512) 943-4506
(512) 943-4515
Mailing address
1103 WILLIAMS DRIVE, BLD4, STE1, GEORGETOWN, TX 78628
(512) 943-4506
(512) 943-4515
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
46-3410679
TX
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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