Registry details
Type
Individual
Primary specialty
Internal Medicine, Pulmonary Disease
Enumerated
Sep 10, 2007
License(s)
N2359 (TX), 45748 (KY), N2359 (TX), 200701973 (NC), 251622 (NY), 251622 (NY), 200701973 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 920 CHURCH ST N | Concord, NC 28025 | 347-804-9172 |
| MAILING | 1073 SING SING RD APT. C1 | Horseheads, NY 14845-1389 | 469-417-7569 |
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