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1548012297
KENLI T BLACK
GARDENA, CA
NPI
1548012297
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172V00000X Community Health Worker
Enumeration Date
2024-04-04
Last Update Date
2024-04-04
Business Address
KENLI T BLACK community peer
1225 W 190TH ST STE 280
GARDENA, CA 90248-4305
Phone number: 877-515-8113
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Mailing Address
KENLI T BLACK community peer
1729 1/2 W ADAMS BLVD
LOS ANGELES, CA 90018-2702
Phone number: 916-730-6253
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