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1417403163
MIRACLE KENNON
LOS ANGELES, CA
NPI
1417403163
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
374U00000X Home Health Aide
(Licence: CA D8116361)
Enumeration Date
2016-08-31
Last Update Date
2016-08-31
Business Address
-- MIRACLE KENNON
711 W 54TH ST
LOS ANGELES, CA 90037-3723
Phone number: 323-593-1035
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Mailing Address
-- MIRACLE KENNON
711 W 54TH ST
LOS ANGELES, CA 90037
Phone number: 323-593-1035
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