Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Nov 21, 2007
License(s)
2011007275 (MO), 2011007275 (MO), 2015-00788 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 1845 | Statesville, NC 28687-1845 | 704-873-4277 |
| LOCATION | 1818 DAVIE AVE | Statesville, NC 28677 | 704-873-1036 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.