Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 21, 2013
License(s)
35698 (SC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 171 ASHLEY AVE | Charleston, SC 29425-8908 | 843-792-1414 |
| MAILING | PO BOX 751461 | Charlotte, NC 28275-1461 | 843-792-6200 |
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