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1699192617
FRED GAMMON
RIVERTON, KS
NPI
1699192617
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: KS 1139)
Enumeration Date
2014-03-27
Last Update Date
2014-03-27
Business Address
FRED GAMMON T-LAC
6610 SE QUAKERVALE RD
RIVERTON, KS 66770-4185
Phone number: 620-848-2300
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Mailing Address
FRED GAMMON T-LAC
PO BOX 550
RIVERTON, KS 66770-0550
Phone number: 620-848-2300
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