Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
May 12, 2006
License(s)
0101277618 (VA), 9500492 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 213 S JEFFERSON ST STE 1006 | Roanoke, VA 24011-1713 | |
| LOCATION | 180 FLOYD AVE | Rocky Mount, VA 24151-1318 | 540-489-6353 |
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