Organization
CLEAN & SOBER LIVING CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL GWARTNEY (CFO)
(949) 278-2843
Entity
Organization
Contact information
Practice address
260 VICTORIA ST APT C1, COSTA MESA, CA 92627-6002
(949) 836-8779
Mailing address
23665 BIRTCHER DR, LAKE FOREST, CA 92630-1770
(949) 278-2843
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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