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1255875571
DISNEY KULACHATI SAMUTSAKORN
FORT BRAGG, NC
NPI
1255875571
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NC 1138817)
Enumeration Date
2016-12-05
Last Update Date
2023-10-23
Business Address
DISNEY KULACHATI SAMUTSAKORN PA-C
2817 REILLY ST
FORT BRAGG, NC 28310-4504
Phone number: 910-907-6000
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Mailing Address
DISNEY KULACHATI SAMUTSAKORN PA-C
2817 REILLY ST
FORT BRAGG, NC 28310-7324
Phone number: 910-907-6000
Copy
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