Provider First Line Business Practice Location Address:
0228 STREET 112
Provider Second Line Business Practice Location Address:
CHAMPUS KAEK, PREK THMEY, MEANCHEY
Provider Business Practice Location Address City Name:
PHNOM PENH
Provider Business Practice Location Address State Name:
PHNOM PENH
Provider Business Practice Location Address Postal Code:
00000
Provider Business Practice Location Address Country Code:
KH
Provider Business Practice Location Address Telephone Number:
855978500448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2014