Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Apr 10, 2011
License(s)
MD.205556 (LA), 41753 (AL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1851 N MCKENZIE ST STE 104 | Foley, AL 36535-4704 | 251-424-1880 |
| MAILING | PO BOX 746984 | Atlanta, GA 30374-6984 | 251-424-1880 |
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