Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 20, 2010
License(s)
284559 (NY), 27230 (OK), N7769 (TX), N7769 (TX), N7769 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 888 S GREENVILLE AVE STE 304 | Richardson, TX 75081-5044 | 469-684-5450 |
| MAILING | 4927 LAKE RIDGE PKWY STE 100 | Grand Prairie, TX 75052 |
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