Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
Jan 23, 2009
License(s)
012776 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 104 UNION AVE SUITE 804 | Syracuse, NY 13203-1843 | 315-703-5049 |
| LOCATION | 301 PROSPECT AVE | Syracuse, NY 13203-1807 | 315-448-5111 |
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