KENNETH LAKE CORNOG

PORTLAND, OR
NPI1962289470
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2023-09-11
Last Update Date2023-09-11
Business Address
KENNETH LAKE CORNOG
3231 SE 50TH AVE
PORTLAND, OR 97206-2248
Phone number: 503-238-5203
Mailing Address
KENNETH LAKE CORNOG
3250 SE 15TH AVE APT 1
PORTLAND, OR 97202-2358
Phone number: 518-409-6158
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