Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 3, 2011
License(s)
21893 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 512185 | Los Angeles, CA 90051-0185 | |
| LOCATION | 1500 DUARTE RD | Duarte, CA 91010-3012 | 626-256-4673 |
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