JOHN GERARD LILLO

GRANTS, NM
NPI1790972644
Professional NameJOHN GERARD LILLO
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: NM  94pa31)
Enumeration Date2007-09-25
Last Update Date2007-09-25
Business Address
Mr. JOHN GERARD LILLO pa
LOBO CANYON RD WESTERN NEW MEXICO CORRECTIONS
GRANTS, NM 87020-0250
Phone number: 505-876-8360
Mailing Address
Mr. JOHN GERARD LILLO pa
PO BOX 250
GRANTS, NM 87020-0250
Phone number: 505-876-8360
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