Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 8, 2015
License(s)
2025010837 (MO), 211573 (AK)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2751 DEBARR RD STE 360 | Anchorage, AK 99508-6809 | 907-792-7920 |
| MAILING | PO BOX 75588 | Chicago, IL 60675-5588 | 907-792-7920 |
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