Registry details
Type
Individual
Primary specialty
Dermatology, Procedural Dermatology
Enumerated
Sep 27, 2007
License(s)
37128 (AL), 290109 (NY), 012082 (NY), 37128 (AL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 516 OLD COUNTRY RD | Plainview, NY 11803-4924 | 205-933-0987 |
| MAILING | 516 OLD COUNTRY RD | Plainview, NY 11803-4924 |
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