Organization
LIBERTY III MANAGEMENT TR
Active
Other names
Professional Medical Oxygen
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORNEJO SR. (GENERAL MANAGER)
(623) 587-0012
Entity
Organization
Contact information
Practice address
21620 N 19TH AVE, A102, PHOENIX, AZ 85027-2716
(623) 587-0012
(623) 587-7533
Mailing address
PO BOX 86658, PHOENIX, AZ 85080-6658
(602) 509-2001
(623) 587-7533
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
07498747M
AZ
Other
Enumeration date
01/08/2007
Last updated
11/02/2011
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