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1174740922
PHOUTHOVONG SOUTHIYANON
SACRAMENTO, CA
NPI
1174740922
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-04-20
Last Update Date
2007-07-08
Business Address
-- PHOUTHOVONG SOUTHIYANON
601 NORTH MARKET BLVD STE 100 NORTHGATE POINT RST
SACRAMENTO, CA 95834
Phone number: 916-567-4222
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Mailing Address
-- PHOUTHOVONG SOUTHIYANON
601 NORTH MARKET BLVD STE 100
SACRAMENTO, CA 95834
Phone number: 916-567-4222
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