Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jun 26, 2017
License(s)
2023-02279 (NC), 2023-02279 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1550 FAULK ST | Monroe, NC 28112-5086 | 980-442-0430 |
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 |
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