KEITH SOURS

MODESTO, CA
NPI1326349994
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2010-11-12
Last Update Date2010-11-12
Business Address
Mr. KEITH SOURS
103 MODESTO AVE
MODESTO, CA 95354-0414
Phone number: 209-527-4597
Mailing Address
Mr. KEITH SOURS
103 MODESTO AVE
MODESTO, CA 95354-0414
Phone number: 209-527-4597
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