Individual
ANTHONY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2424 RENDOVA RD, SAN DIEGO, CA 92155-5041
(619) 537-3941
Mailing address
2931 GABRIELSON AVE, SAN DIEGO, CA 92111-5814
(760) 401-7807
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/20/2014
Last updated
06/24/2014
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