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1164011201
PETAMPHONE VANLATHANITH
FREMONT, CA
NPI
1164011201
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2021-01-13
Last Update Date
2021-01-13
Business Address
PETAMPHONE VANLATHANITH
39201 STATE ST
FREMONT, CA 94538-1437
Phone number: 866-206-2008
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Mailing Address
PETAMPHONE VANLATHANITH
39201 STATE ST
FREMONT, CA 94538-1437
Phone number: 866-206-2008
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