Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jul 20, 2006
License(s)
004533 (GA), 052722 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 111 MARBLE MILL ROAD | Marietta, GA 30060-1047 | 770-422-1013 |
| LOCATION | 111 MARBLE MILL ROAD | Marietta, GA 30060-1047 | 770-422-1013 |
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