Registry details
Type
Individual
Primary specialty
Orthopaedic Surgery
Enumerated
Jun 22, 2012
License(s)
5344 (OK), 5344 (OK), 86481 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1305 JENNINGS MILL RD STE 110 | Watkinsville, GA 30677-7241 | 706-613-5880 |
| MAILING | PO BOX 117265 | Atlanta, GA 30368-7265 |
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