Registry details
Type
Individual
Primary specialty
Psychiatry & Neurology, Psychiatry
Enumerated
Jul 2, 2015
License(s)
53296 (KY), 53296 (KY), 125066456 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 635283 | Cincinnati, OH 45263-5283 | 859-301-5901 |
| LOCATION | 605 MAN O WAR BLVD | Union, KY 41091-2017 | 859-757-0717 |
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