Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 12, 2015
License(s)
50-004243 (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 74216 | Cleveland, OH 44194-0002 | 440-879-0081 |
| LOCATION | 1730 W 25TH ST | Cleveland, OH 44113-3108 | 216-696-4300 |
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