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1013419407
MIKIE INTHAVONG
FRESNO, CA
NPI
1013419407
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2018-03-02
Last Update Date
2018-03-02
Business Address
MIKIE INTHAVONG
1220 N FINE AVE
FRESNO, CA 93727-1916
Phone number: 559-231-1304
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Mailing Address
MIKIE INTHAVONG
1220 N FINE AVE
FRESNO, CA 93727-1916
Phone number: 559-231-1304
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