SUSADA INTHAVONG

SOUTH WINDSOR, CT
NPI1275770398
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: CT  003968)
Enumeration Date2009-01-12
Last Update Date2009-01-12
Business Address
-- SUSADA INTHAVONG APRN
1504 SULLIVAN AVE
SOUTH WINDSOR, CT 06074-2711
Phone number: 860-644-1523
Mailing Address
-- SUSADA INTHAVONG APRN
29 NAEK RD SUITE 5
VERNON, CT 06066-3942
Phone number: 860-872-2289
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