Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 16, 2014
License(s)
0010-04767 (NC), PA1787 (NV)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 100 KIMEL FOREST DR | Winston Salem, NC 27103-6074 | 336-716-0238 |
| LOCATION | 601 N ELM ST | High Point, NC 27262-4331 | 336-885-6168 |
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