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1962251819
KEAN GIRESSE GOUE
SOUTH SALT LAKE, UT
NPI
1962251819
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
175T00000X Peer Specialist
(Licence: UT F24-112840)
Enumeration Date
2024-05-14
Last Update Date
2024-05-14
Business Address
KEAN GIRESSE GOUE
177 W PRICE AVE
SOUTH SALT LAKE, UT 84115-4345
Phone number: 801-503-4369
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Mailing Address
KEAN GIRESSE GOUE
177 W PRICE AVE
SOUTH SALT LAKE, UT 84115-4345
Phone number: 801-503-4369
Copy
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