Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jul 5, 2006
License(s)
49830020 (WI), 01086313A (IN), 2010032296 (MO)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 637764 | Cincinnati, OH 45263-7764 | 317-880-3939 |
| LOCATION | 6002 E 38TH ST | Indianapolis, IN 46226-5614 | 317-880-6002 |
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