NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1275500100
GRIMM
ELLEN
M.
 
12221 N MOPAC EXPY
AUSTIN
TX
787582401
1316137722
REN
QING
 
 
12221 N MOPAC EXPY
AUSTIN
TX
787582401
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