Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Mar 24, 2018
License(s)
2021-00710 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 | |
| LOCATION | 2001 VAIL AVE STE 400 | Charlotte, NC 28207-1248 | 704-304-7000 |
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