Organization
LIA ST JUNIUS
Active
Other names
MOBILITY STORE
Organization subpart
No
Provider details
NPI number
Authorized official
LIA ST. JUNIUS (OWNER)
(888) 432-1375
Entity
Organization
Contact information
Practice address
505 W WILLOW ST, LONG BEACH, CA 90806-2830
(562) 989-6308
(562) 989-6306
Mailing address
PO BOX 821, FRESNO, TX 77545-0821
(888) 432-1375
(713) 432-1395
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0086788
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176699002
—
TX
Enumeration date
05/19/2006
Last updated
06/30/2008
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