PHAYLOTH CHANDAVONG

SACRAMENTO, CA
NPI1669729281
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2012-08-14
Last Update Date2012-08-14
Business Address
-- PHAYLOTH CHANDAVONG
7225 E SOUTHGATE DR
SACRAMENTO, CA 95823-2652
Phone number: 916-394-1000
Mailing Address
-- PHAYLOTH CHANDAVONG
7225 E SOUTHGATE DR
SACRAMENTO, CA 95823-2652
Phone number:
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