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1053060202
KELLY KEOMUANGCHANH
MODESTO, CA
NPI
1053060202
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-03-23
Last Update Date
2022-03-23
Business Address
KELLY KEOMUANGCHANH
2630 W RUMBLE RD
MODESTO, CA 95350-0155
Phone number: 209-222-2378
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Mailing Address
KELLY KEOMUANGCHANH
2630 W RUMBLE RD
MODESTO, CA 95350-0155
Phone number: 209-222-2378
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