Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Apr 3, 2006
License(s)
4021903 (NC), 01814 (WV), 054057 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 106 JADE SPRING CT. | Mooresville, NC 28117 | 704-987-1498 |
| LOCATION | 1601 WATSON BLVD | Warner Robins, GA 31093-3431 | 478-333-3603 |
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