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1457471005
ILLYA CLEMMONS
LOS ANGELES, CA
NPI
1457471005
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-03-29
Last Update Date
2007-07-08
Business Address
-- ILLYA CLEMMONS
9512 ANZAC AVE
LOS ANGELES, CA 90002-2517
Phone number: 323-564-1864
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Mailing Address
-- ILLYA CLEMMONS
10950 S CENTRAL AVE
LOS ANGELES, CA 90059-1024
Phone number: 310-563-5639
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