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1114433927
NICO TANK
LA PUENTE, CA
NPI
1114433927
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1268591017)
Enumeration Date
2017-12-18
Last Update Date
2017-12-18
Business Address
NICO TANK
15229 AMAR RD
LA PUENTE, CA 91744-2066
Phone number: 626-855-5090
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Mailing Address
NICO TANK
4019 3/4 MUSCATEL AVE
ROSEMEAD, CA 91770-1349
Phone number: 626-615-3568
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