Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 22, 2011
License(s)
PA07107 (TX), PA07107 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 746768 | Atlanta, GA 30374-6768 | 512-359-7546 |
| LOCATION | 12319 N MOPAC EXPY STE 100 | Austin, TX 78758-2486 | 512-837-3376 |
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