Registry details
Type
Individual
Primary specialty
Nuclear Medicine, Nuclear Cardiology
Enumerated
May 23, 2007
License(s)
4301083820 (MI), 51029 (MN), 036131194 (IL), 036131194 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 1105 | Indianapolis, IN 46206-1105 | 618-457-5200 |
| LOCATION | 409 W OAK ST | Carbondale, IL 62901-1414 | 618-529-4455 |
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