Mary Souvanna

NPI #1750670485 in Benton, Arkansas

Provider Information

NPI Number: 1750670485
Entity Type: Individual
Name: Mary Souvanna
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: Apr 4, 2011
Last Updated: Apr 4, 2011

Practice Location

Address: 3214 WINCHESTER
City: Benton
State: Arkansas
ZIP Code: 72015-2929
Phone: (501) 326-6160

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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