Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
May 31, 2019
License(s)
2024-01679 (NC), ME147926 (FL), 2024-01679 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 2675 WINKLER AVE FL 2 | Fort Myers, FL 33901-9342 | |
| LOCATION | 13813 METRO PKWY | Fort Myers, FL 33912-4343 | 855-674-4624 |
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