Individual
LIA S ST. JUNIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
505 W WILLOW ST, LONG BEACH, CA 90806-2830
(562) 989-6306
(888) 432-1395
Mailing address
PO BOX 821, FRESNO, TX 77545-0821
(562) 989-6306
(888) 432-1395
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0086788
TX
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0086788
TX
Other
Enumeration date
03/21/2007
Last updated
04/10/2008
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