Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
May 12, 2023
License(s)
0010-13308 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1901 BRUNSWICK AVE STE 200 | Charlotte, NC 28207-1897 | 704-316-5025 |
| MAILING | PO BOX 60447 | Charlotte, NC 28260-0447 |
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