Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Mar 27, 2018
License(s)
39243 (OK)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1215 21ST AVE S STE 5468A | Nashville, TN 37232-1458 | 615-936-4986 |
| MAILING | 1215 21ST AVE S STE 5468A | Nashville, TN 37232-1458 | 615-936-4986 |
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