Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Mar 22, 2021
License(s)
2023-01317 (NC), 2023-01317 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1456 N HOWE ST STE 101 | Southport, NC 28461-2674 | 910-994-3917 |
| LOCATION | 1456 N HOWE ST STE 101 | Southport, NC 28461-2674 | 910-994-3917 |
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