Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 15, 2012
License(s)
0010-03917 (NC), 0010-03917 (NC), 0010-03917 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1917 W PARK DR | North Wilkesboro, NC 28659-3585 | 336-716-2255 |
| MAILING | MEDICAL CENTER BLVD | Winston Salem, NC 27157-0001 | 336-716-2255 |
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