Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 18, 2020
License(s)
MT220760 (PA), 68804 (AZ)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 7600 N 15TH ST STE 190 | Phoenix, AZ 85020-4348 | 602-200-3800 |
| MAILING | PO BOX 35380 | Las Vegas, NV 89133-5380 | 702-579-3203 |
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