KENNETH ELAD FONGUCK

WOONSOCKET, RI
NPI1265028781
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy163W00000X Registered Nurse
(Licence: GA  296175)
Enumeration Date2020-12-18
Last Update Date2020-12-18
Business Address
KENNETH ELAD FONGUCK
1 CVS DR
WOONSOCKET, RI 02895-6146
Phone number: 402-419-6291
Mailing Address
KENNETH ELAD FONGUCK
2500 PLEASANT HILL RD APT 1517
DULUTH, GA 30096-4188
Phone number:
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