Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 9, 2016
License(s)
31124 (WV), 0101273821 (VA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1840 AMHERST ST | Winchester, VA 22601-2808 | 540-536-8750 |
| MAILING | PO BOX 880 | Lima, OH 45802-0880 | 866-482-5419 |
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