Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
May 26, 2015
License(s)
0010-05811 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 7210 VILLAGE MEDICAL CIR STE 110 | Clemmons, NC 27012-8041 | 336-893-2400 |
| MAILING | PO BOX 60447 | Charlotte, NC 28260-0447 |
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