CA Wall License 1615 Information
| Name | Chantal Russell |
| License Number | 1615 |
| Individual or Organization | O |
| Address | 10793 Tierrasanta Blvd, Ste A
San Diego, CA 92124 |
| County | San Diego |
| License Status | Active |
| License Original Issue Date | 10/17/2021 |
| License Expiration Date | 9/30/2023 |
| License Type | Wall License |
| Agency | Acupuncture Board |