Lao Pha

NPI #1245639301 in Big Lake, Minnesota

Provider Information

NPI Number: 1245639301
Entity Type: Individual
Name: Lao Pha
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Driver
Enumeration Date: Aug 14, 2014
Last Updated: Aug 14, 2014

Practice Location

Address: 171 LAKE ST N # 102
City: Big Lake
State: Minnesota
ZIP Code: 55309-9254
Phone: (651) 774-1166

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary

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