Individual
KOSAL SUON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
126 PHOENIX AVE, 2RD FLOOR, LOWELL, MA 01852-4931
(978) 937-3087
Mailing address
PO BOX 8025, LOWELL, MA 01853-8025
(978) 935-6884
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/01/2010
Last updated
12/13/2010
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