Organization
JACK G MCCULLOCH JR
Active
Other names
McCulloch's Wide Shoes
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. APRYL H MCCULLOCH C.PED. (CO-OWNER)
(714) 529-6399
Entity
Organization
Contact information
Practice address
685 S BREA BLVD, BREA, CA 92821-5308
(714) 529-6399
(714) 529-2859
Mailing address
685 S BREA BLVD, BREA, CA 92821-5308
(714) 529-6399
(714) 529-2859
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/20/2006
Last updated
04/11/2013
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