Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Oct 11, 2005
License(s)
MD051529L (PA), MD051529L (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 6 S GREENVIEW RD | Schuylkill Haven, PA 17972 | 570-366-3915 |
| MAILING | PO BOX 783311 | Philadelphia, PA 19178-3311 | 484-884-4500 |
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