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1588941660
CHAD RUSSELL HANSEN
SAN DIEGO, CA
NPI
1588941660
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2011-11-03
Last Update Date
2011-11-03
Business Address
-- CHAD RUSSELL HANSEN IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 520-289-6568
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Mailing Address
-- CHAD RUSSELL HANSEN IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 520-289-6568
Copy
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