Organization
SUNDARA ACUPUNCTURE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHAVIXAY SUNDARA LAC (ACUPUNTURIST)
(503) 382-7179
Entity
Organization
Contact information
Practice address
17175 SW LISA ST, BEAVERTON, OR 97006-4185
(503) 382-7179
Mailing address
17175 SW LISA ST, BEAVERTON, OR 97006-4185
(503) 382-7179
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
AC151174
OR
Other
Enumeration date
02/28/2013
Last updated
02/28/2013
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