Organization
LICE CLINICS OF AMERICA WESTERN TERRITORIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL COLEMAN (LICENSEE/MANAGER)
(512) 620-2243
Entity
Organization
Contact information
Practice address
322 CERNON ST, VACAVILLE, CA 95688-4502
(855) 500-5423
Mailing address
322 CERNON ST, VACAVILLE, CA 95688-4502
(855) 500-5423
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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