Individual
KINGSLEY EROMOSELE USIANENEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2308 COBBLESTONE BLVD, FAYETTEVILLE, GA 30215-6843
(678) 516-8594
Mailing address
2308 COBBLESTONE BLVD, FAYETTEVILLE, GA 30215-6843
(678) 516-8594
Taxonomy
Speciality
Code
Description
License number
State
225600000X
Dance Therapist
Primary
—
—
Other
Enumeration date
10/15/2008
Last updated
10/15/2008
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