Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jan 5, 2006
License(s)
60105 (GA), 60105 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 216 GLENDALE AVE | Decatur, GA 30030-1918 | 678-480-4095 |
| LOCATION | 150 E PONCE DE LEON AVE STE 150 | Decatur, GA 30030-2566 | 404-566-5056 |
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