PHOKHAM MIKE SOURIVANH

APO, AP
NPI1972022762
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy171000000X Military Health Care Provider
Enumeration Date2017-09-13
Last Update Date2022-04-21
Business Address
Mr. PHOKHAM MIKE SOURIVANH PA-C
CAMP PENDLETON
APO, AP 92055
Phone number: 760-725-1288
Mailing Address
Mr. PHOKHAM MIKE SOURIVANH PA-C
CAMP PENDLETON
APO, AP 92055
Phone number:
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