PHANTHABOON PHANNAVONG

SEATTLE, WA
NPI1831850791
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: WA  PA61358368)
Enumeration Date2022-01-04
Last Update Date2022-11-24
Business Address
PHANTHABOON PHANNAVONG
2671 NE 46TH ST
SEATTLE, WA 98105-5041
Phone number: 206-525-8000
Mailing Address
PHANTHABOON PHANNAVONG
26413 LESLIE AVE
EUCLID, OH 44132-2527
Phone number: 216-250-1293
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