Individual
MARIA ANTILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 WIND RIVER DR, B, GREEN RIVER, WY 82935-5725
(307) 875-5781
Mailing address
720 WIND RIVER DR, B, GREEN RIVER, WY 82935-5725
(307) 875-5781
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
06/12/2007
Last updated
07/08/2007
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