SOUKSAVANH LISA PHANTHAVONG

FLOWER MOUND, TX
NPI1619222874
Former NameSOUKSAVANH LISA BUSH
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: TX  PA07876)
Enumeration Date2012-07-13
Last Update Date2017-01-11
Business Address
-- SOUKSAVANH LISA PHANTHAVONG PA-C
4001 LONG PRAIRIE RD STE 125
FLOWER MOUND, TX 75028-1532
Phone number: 972-539-3030
Mailing Address
-- SOUKSAVANH LISA PHANTHAVONG PA-C
4001 LONG PRAIRIE RD STE 125
FLOWER MOUND, TX 75028-1532
Phone number: 972-539-3030
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