Individual
EDWARD JOHAN GOMILLION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3227 E BELL RD, SUITE 201, PHOENIX, AZ 85032-2700
(602) 485-8434
Mailing address
3227 E BELL RD, SUITE 201, PHOENIX, AZ 85032-2700
(602) 485-8434
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT04378P
AZ
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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