CA Wall License 2520

CA Wall License 2520 Information

Name Makha Phetphommasouk
License Number2520
Individual or OrganizationO
Address2801 Yulupa Ave. Suite B
Santa Rosa, CA 95405
CountySonoma
License StatusActive
License Original Issue Date3/7/2022
License Expiration Date2/29/2024
License TypeWall License
AgencyAcupuncture Board