Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Sep 9, 2019
License(s)
085001089 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 512 | Greenville, IL 62246-0512 | 618-664-2914 |
| LOCATION | GRAHAM CORRECTIONAL CENTER 12078 ILLINOIS RTE 185 | Hilliboro, IL 62049 | 217-532-6961 |
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