Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 21, 2005
License(s)
9400198 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 13539 REESE BLVD W STE B | Huntersville, NC 28078-7961 | 704-892-4878 |
| MAILING | 1072 X RAY DR STE B | Gastonia, NC 28054-7488 | 704-671-1094 |
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