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1669080693
JACK LAVIVONG
LAS VEGAS, NV
NPI
1669080693
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2020-07-15
Last Update Date
2020-07-15
Business Address
JACK LAVIVONG
5858 S PECOS RD # I-100
LAS VEGAS, NV 89120-5401
Phone number: 702-855-3382
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Mailing Address
JACK LAVIVONG
5858 S PECOS RD # I-100
LAS VEGAS, NV 89120-5401
Phone number:
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