Individual
AMBERLY ANTANA INTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4222 DUNDEE AVE, COLUMBUS, OH 43227-3639
(614) 584-8894
Mailing address
4222 DUNDEE AVE, COLUMBUS, OH 43227-3639
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/23/2023
Last updated
04/02/2025
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