Individual
MS. MARY L CAROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P A C
Contact information
Practice address
175 S UNION BLVD, STE 345, COLORADO SPRINGS, CO 80910
(719) 471-7158
(719) 471-7159
Mailing address
5955 WILSON ROAD, COLORADO SPRINGS, CO 80919-3553
(719) 548-9182
(719) 593-1512
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
498
CO
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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