DANE EDWARD WEATHERFORD

SAN DIEGO, CA
NPI1053686824
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy171000000X Military Health Care Provider
Enumeration Date2012-03-13
Last Update Date2012-03-13
Business Address
Mr. DANE EDWARD WEATHERFORD IDC
10209 HOOPER ST
SAN DIEGO, CA 92124-3509
Phone number: 860-501-0511
Mailing Address
Mr. DANE EDWARD WEATHERFORD IDC
10209 HOOPER ST
SAN DIEGO, CA 92124-3509
Phone number: 860-501-0511
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