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1992823264
SHAD FOSSEN
LONG BEACH, CA
NPI
1992823264
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225400000X Rehabilitation Practitioner
Enumeration Date
2007-03-26
Last Update Date
2013-05-24
Business Address
Mr. SHAD FOSSEN
456 ELM AVE
LONG BEACH, CA 90802-2426
Phone number: 562-437-6717
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Mailing Address
Mr. SHAD FOSSEN
508 AGUA PL
SEAL BEACH, CA 90740-6216
Phone number:
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