Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Aug 5, 2007
License(s)
BP10029412 (TX), N4239 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 313 E 12TH ST SUITE 101 | Austin, TX 78701-1954 | 512-324-9650 |
| MAILING | 1601 RIO GRANDE ST SUITE 340 | Austin, TX 78701-1137 | 512-324-8960 |
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