Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 5, 2010
License(s)
85080 (GA), 036.132404 (IL), 85080 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 790 CHURCH ST NE STE 400 | Marietta, GA 30060-8957 | 770-405-2976 |
| MAILING | PO BOX 3157 | Indianapolis, IN 46206-3157 | 770-405-2976 |
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