KIRBY NALUCK KHOONSRIVONG

STOCKTON, CA
NPI1265679591
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2009-01-08
Last Update Date2009-01-08
Business Address
-- KIRBY NALUCK KHOONSRIVONG
10309 BIG OAK CIR
STOCKTON, CA 95209-4560
Phone number: 209-513-2680
Mailing Address
-- KIRBY NALUCK KHOONSRIVONG
10309 BIG OAK CIR
STOCKTON, CA 95209-4560
Phone number: 209-513-2680
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