Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 29, 2011
License(s)
MD465946 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 678678 | Dallas, TX 75267-8678 | 800-475-6112 |
| LOCATION | 255 W LANCASTER AVE | Paoli, PA 19301-1763 | 484-565-1074 |
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