Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Apr 12, 2007
License(s)
0010-03248 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1912 TRADD CT | Wilmington, NC 28401-6637 | 910-251-3766 |
| MAILING | PO BOX 936857 | Atlanta, GA 31193-6857 |
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