Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Apr 23, 2026
License(s)
MT236399 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5846 PRIKAPA CT | Las Vegas, NV 89118-6074 | 725-310-0866 |
| LOCATION | 200 SCHUYLKILL MEDICAL PLZ | Pottsville, PA 17901-3660 | 570-621-9283 |
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