Individual
MR. ANDREW DIMOS DIMITRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
810 LAKEVIEW DR, CROSS LANES, WV 25313-1448
(304) 395-5635
Mailing address
810 LAKEVIEW DR, CROSS LANES, WV 25313-1448
(304) 395-5635
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0995
WV
Other
Enumeration date
06/15/2010
Last updated
06/15/2010
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