Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Apr 8, 2021
License(s)
0010-14440 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1004 PROCURE ST STE 100 | Fuquay Varina, NC 27526-2620 | 919-577-0085 |
| MAILING | 9626 VINCA CIR APT A | Charlotte, NC 28213-0012 | 704-763-0721 |
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