Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 6, 2006
License(s)
0010-02511 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 602658 | Charlotte, NC 28260-2658 | 336-716-2011 |
| LOCATION | 2311 LEWISVILLE CLEMMONS RD | Clemmons, NC 27012-8905 | 336-713-0400 |
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