Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 19, 2006
License(s)
21622 (NE), 21622 (NE), ME65324 (FL), 01073672A (IN), 01073672A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 9628 WEXFORD RD | Jacksonville, FL 32257-5751 | 904-945-1901 |
| MAILING | 3900 ST FRANCIS WAY SUITE 215 | Lafayette, IN 47905-4925 | 765-446-4819 |
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