Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jul 12, 2006
License(s)
30949 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1605 WHITESVILLE ST | Lagrange, GA 30240-5903 | 706-882-5119 |
| LOCATION | 1605 WHITESVILLE ST | Lagrange, GA 30240-5903 | 706-882-5119 |
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