Individual
MR. LARRY EDWARD TERRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC III
Contact information
Practice address
1711 E EVANS AVE, PUEBLO, CO 81004-3349
(719) 561-9850
Mailing address
3470 BALTIMORE AVE, PUEBLO, CO 81008-1520
(719) 545-1181
(719) 545-4097
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3164
CO
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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