Registry details
Type
Individual
Primary specialty
Dermatology, Procedural Dermatology
Enumerated
Apr 20, 2007
License(s)
M6002 (TX), M6002 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1651 ROCK PRAIRIE RD STE 103 | College Station, TX 77845-8652 | 979-314-5400 |
| MAILING | 1651 ROCK PRAIRIE RD STE 103 | College Station, TX 77845-8652 | 979-314-5400 |
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