Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Apr 7, 2020
License(s)
2023-01935 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 60447 | Charlotte, NC 28260-0447 | |
| LOCATION | 7903 PROVIDENCE RD STE 100 | Charlotte, NC 28277-9763 | 704-316-4460 |
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