Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 14, 2006
License(s)
051610 (GA), 18764 (KY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 530 BOULDER WAY | Roswell, GA 30075-4160 | 865-985-7186 |
| LOCATION | 710 CENTER ST | Columbus, GA 31901-1527 | 706-571-1064 |
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