Organization
MP LO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J LO (OWNER)
(262) 364-9356
Entity
Organization
Contact information
Practice address
901 ELK CREEK RD, CRESCENT CITY, CA 95531-8556
(262) 364-9356
Mailing address
901 ELK CREEK RD, CRESCENT CITY, CA 95531-8556
(262) 364-9356
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
10/07/2021
Last updated
05/31/2022
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