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1104169127
KEITH GERARD DAVIS
LOS ANGELES, CA
NPI
1104169127
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2013-03-27
Last Update Date
2013-03-27
Business Address
Mr. KEITH GERARD DAVIS
4715 CRENSHAW BLVD
LOS ANGELES, CA 90043-1233
Phone number: 323-988-3744
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Mailing Address
Mr. KEITH GERARD DAVIS
4715 CRENSHAW BLVD
LOS ANGELES, CA 90043-1233
Phone number: 323-988-3744
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