Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jul 24, 2014
License(s)
MD15807 (RI), 2023-02649 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1638 OWEN DR | Fayetteville, NC 28304-3424 | 910-615-5680 |
| MAILING | 117 ELLENFIELD ST STE 101 | Providence, RI 02905-4513 | 401-444-6779 |
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