Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Dec 17, 2025
License(s)
LT001091 (PA), LT001091 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 858 MC CA410 | Hershey, PA 17033-0858 | 800-243-1455 |
| LOCATION | 500 UNIVERSITY DR | Hershey, PA 17033-2360 | 717-531-6597 |
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