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1508577800
BRIAN J LONG
KINGMAN, AZ
NPI
1508577800
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YP1600X Counselor Pastoral
(Licence: AZ 22972)
Enumeration Date
2022-12-07
Last Update Date
2022-12-07
Business Address
BRIAN J LONG BA
1850 GATES AVE
KINGMAN, AZ 86401-8003
Phone number: 928-377-0453
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Mailing Address
BRIAN J LONG BA
4085 N VAN NUYS RD
KINGMAN, AZ 86409-2544
Phone number: 928-377-0453
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