JONATHAN DAC-MOANG LIEM

BLACKFOOT, ID
NPI1235903279
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: ID  PT-8771)
Enumeration Date2023-11-09
Last Update Date2023-11-09
Business Address
JONATHAN DAC-MOANG LIEM DPT
1441 PARKWAY DR STE 1
BLACKFOOT, ID 83221-1667
Phone number: 208-785-3446
Mailing Address
JONATHAN DAC-MOANG LIEM DPT
1441 PARKWAY DR STE 1
BLACKFOOT, ID 83221-1667
Phone number: 208-785-3446
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