Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jul 27, 2010
License(s)
PA21045 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 800 S CENTRAL AVE STE 308 | Glendale, CA 91204-4644 | 818-549-8800 |
| MAILING | 519 E BROADWAY | Glendale, CA 91205-1110 | 818-409-3020 |
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