Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 16, 2012
License(s)
PA4570 (MA), PA4570 (MA), 50.005976RX (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 410 W 10TH AVE | Columbus, OH 43210-1240 | 614-293-8000 |
| MAILING | 700 ACKERMAN RD STE 2120 | Columbus, OH 43202-1559 | 614-366-8030 |
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