Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Apr 25, 2007
License(s)
036.136385 (IL), 35.091371 (OH), 036.136385 (IL), A107186 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1500 DUARTE RD | Duarte, CA 91010-3012 | 626-256-4673 |
| MAILING | PO BOX 512185 | Los Angeles, CA 90051-0185 | 626-775-3514 |
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