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Individual

BUNLERT ELIZABETH KHAMPHAMODENE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2235 CAPISTRANO AVE, LAS VEGAS, NV 89169-1801
(702) 490-1837
Mailing address
2235 CAPISTRANO AVE, LAS VEGAS, NV 89169-1801
(702) 490-1837

Taxonomy

Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary

Other

Enumeration date
07/20/2011
Last updated
07/20/2011
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