Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Nov 7, 2020
License(s)
PA9116106 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 830 WASHINGTON ST | Watertown, NY 13601-4099 | 315-785-4000 |
| MAILING | 25400 STEWART DR | Carthage, NY 13619-7501 | 763-226-4538 |
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