Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jul 10, 2008
License(s)
51536 (SC), 2014-02372 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 17210 LANCASTER HWY STE 408 | Charlotte, NC 28277-2093 | 803-855-1707 |
| MAILING | 301 S MCDOWELL ST STE 125-1350 | Charlotte, NC 28204-2623 | 803-855-1707 |
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