Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Apr 29, 2008
License(s)
pa 19613 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 425 DIAMOND DR STE 104&105 | Lake Elsinore, CA 92530-4495 | 951-674-8779 |
| MAILING | PO BOX 35380 | Las Vegas, NV 89133-5380 | 702-579-3203 |
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