Individual
SOUPHA CHANTHINOUVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
812 AVIS DR, ANN ARBOR, MI 48108-9649
(734) 213-3960
Mailing address
2223 LOS FELIZ DR APT 102, THOUSAND OAKS, CA 91362-3090
(734) 394-9536
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
12/27/2013
Last updated
12/27/2013
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