EDGAR CARL DE VAN

WALSENBURG, CO
NPI1215139019
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CO  6541)
Enumeration Date2007-06-04
Last Update Date2007-07-08
Business Address
Mr. EDGAR CARL DE VAN CAC II
615 RUSSELL AVE
WALSENBURG, CO 81089-2127
Phone number: 719-738-2076
Mailing Address
Mr. EDGAR CARL DE VAN CAC II
206 W 3RD ST
WALSENBURG, CO 81089-1904
Phone number: 719-738-1082
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