Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Mar 26, 2007
License(s)
004163 (GA), 001000971 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 128 MEDICAL PARK RD STE 101 | Mooresville, NC 28117-8579 | 704-658-1001 |
| MAILING | PO BOX 1845 | Statesville, NC 28687-1845 | 704-873-4277 |
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