Individual
PHOEUTH YO PHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9707 MAGNOLIA AVE, RIVERSIDE, CA 92503-3609
(951) 358-6858
Mailing address
PO BOX 349, CRESTLINE, CA 92325-0349
(951) 840-8765
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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