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1265679591
KIRBY NALUCK KHOONSRIVONG
STOCKTON, CA
NPI
1265679591
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2009-01-08
Last Update Date
2009-01-08
Business Address
-- KIRBY NALUCK KHOONSRIVONG
10309 BIG OAK CIR
STOCKTON, CA 95209-4560
Phone number: 209-513-2680
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Mailing Address
-- KIRBY NALUCK KHOONSRIVONG
10309 BIG OAK CIR
STOCKTON, CA 95209-4560
Phone number: 209-513-2680
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