Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 11, 2009
License(s)
2012-00505 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3030 RANDOLPH RD STE 102-A | Charlotte, NC 28211-1368 | 704-444-5881 |
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 |
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