Individual
MR. ERAVANH BOUTSOMSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7731 E NORTHERN LIGHTS BLVD, SUITE 220, ANCHORAGE, AK 99504-3554
(907) 727-2720
(907) 332-1490
Mailing address
PO BOX 210856, ANCHORAGE, AK 99521-0856
(907) 727-2720
(907) 332-1490
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
931555
AK
Other
Enumeration date
07/07/2009
Last updated
07/07/2009
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