Licensee Name:LOMA PORTAL PSY FACIL
License Type:DRUG ROOM (FEE EXEMPT)
License Number:19570
License Status:CANCELLED Definition
Expiration Date:November 01, 1996
Issue Date:November 01, 1984
Address:3485 KENYON ST
City:SAN DIEGO
State:CA
Zip:92110
County:SAN DIEGO
Actions:No
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