Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jun 15, 2020
License(s)
MA065206 (PA), 12588184-1206 (UT)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 121 N NYES RD STE F | Harrisburg, PA 17112-3248 | 717-214-6545 |
| MAILING | 4460 S HIGHLAND DR | Salt Lake City, UT 84124-3543 | 888-949-4864 |
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