Organization
ADVANCED ORTHOTICS & PROSTHETICS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW MANUEL CARRILLO I (OWNER)
(601) 649-0001
Entity
Organization
Contact information
Practice address
434 S 13TH AVE, LAUREL, MS 39440-4345
(601) 649-0001
(601) 649-0035
Mailing address
PO BOX 6501, LAUREL, MS 39441-6501
(601) 649-0001
(601) 649-0035
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
12/19/2007
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