Individual
MANOLO CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 W COURT ST, PASCO, WA 99301-3737
(509) 547-2204
Mailing address
PO BOX 1452, PASCO, WA 99301-1452
(509) 547-2204
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH60163723
WA
Other
Enumeration date
11/05/2010
Last updated
11/05/2010
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