KEVIN KHAMVONGSA

CRYSTAL LAKE, IL
NPI1467907170
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy251S00000X Community/Behavioral Health
(Licence: IL  s4s8c5h5)
Enumeration Date2016-08-23
Last Update Date2016-08-23
Business Address
-- KEVIN KHAMVONGSA
145 S VIRGINIA ST
CRYSTAL LAKE, IL 60014-7226
Phone number: 815-444-9999
Mailing Address
-- KEVIN KHAMVONGSA
145 S VIRGINIA ST
CRYSTAL LAKE, IL 60014-7226
Phone number: 815-444-9999
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