DUANGTAVAN SOURIVONG

SAN DIEGO, CA
NPI1285821389
Entity TypeOrganization
Authorized ContactBOBBY STEARNS
Clinic Director
619-262-8000
Organization Subpart ?No
Primary Taxonomy261QM2800X Clinic/Center, Methadone Clinic
Enumeration Date2007-10-02
Last Update Date2007-10-02
Business Address
DUANGTAVAN SOURIVONG
3940 HOME AVE
SAN DIEGO, CA 92105-5952
Phone number: 619-262-8000
Mailing Address
DUANGTAVAN SOURIVONG
4852 JARRETT CT
SAN DIEGO, CA 92113-3598
Phone number:
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