Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 13, 2010
License(s)
PA20512 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1365 S GRAND AVE | Glendora, CA 91740-5047 | 626-857-2580 |
| MAILING | 1556 THOMPSON AVE | Glendale, CA 91201-1230 | 818-265-1699 |
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