Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Aug 29, 2005
License(s)
21671 (SC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 7430 COLLEGE ST | Irmo, SC 29063-2903 | 803-732-4001 |
| MAILING | PO BOX 530062 | Atlanta, GA 30353-0062 | 843-695-6071 |
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