Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Mar 26, 2016
License(s)
MD61177199 (WA), A171006 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 7464 | San Francisco, CA 94120-7464 | |
| LOCATION | 1001 POTRERO AVE BLDG 51 | San Francisco, CA 94110-3518 | 628-206-8020 |
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