Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 12, 2006
License(s)
MA052663 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 900 CHESTNUT STREET EXT STE A | Bradford, PA 16701-2298 | |
| LOCATION | 900 CHESTNUT STREET EXT STE A | Bradford, PA 16701-2298 | 814-368-8490 |
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