Organization
GARY TOLER
Active
Other names
Willie's Specialty Shop
Organization subpart
No
Provider details
NPI number
Authorized official
GARY PAUL TOLER (OWNER)
(714) 771-4312
Entity
Organization
Contact information
Practice address
392 S TUSTIN ST, ORANGE, CA 92866-2502
(714) 771-4310
Mailing address
392 S TUSTIN ST, ORANGE, CA 92866-2502
(714) 771-4310
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
I-105963-L
CA
Other
Enumeration date
03/08/2007
Last updated
08/27/2007
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