Organization
ELLIEMADEAUSTIN
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH TISDALE (OWNER)
(512) 629-7416
Entity
Organization
Contact information
Practice address
1036 STOCKADE RANCH RD, PAIGE, TX 78659-4446
(512) 629-7416
Mailing address
1036 STOCKADE RANCH RD, PAIGE, TX 78659-4446
(512) 629-7416
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
D8764589
CA
Other
Enumeration date
09/23/2014
Last updated
09/23/2014
About Stedi
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