SCOTT GOULD KINGPHAVONG

OAK FOREST, IL
NPI1710333638
Former NameSCOTT ALLEN GOULD
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225700000X Massage Therapist
(Licence: IL  227.014953)
Enumeration Date2016-05-10
Last Update Date2020-10-01
Business Address
Mr. SCOTT GOULD KINGPHAVONG LMT
5936 ESSEX RD
OAK FOREST, IL 60452-2824
Phone number: 779-774-5493
Mailing Address
Mr. SCOTT GOULD KINGPHAVONG LMT
5936 ESSEX RD
OAK FOREST, IL 60452-2824
Phone number: 779-774-5493