Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 13, 2006
License(s)
101902 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 60447 | Charlotte, NC 28260-0447 | 704-384-9960 |
| LOCATION | 10514 PARK RD | Charlotte, NC 28210-8405 | 704-384-9960 |
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