Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Mar 9, 2012
License(s)
2024-00309 (NC), 2024-00309 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 7200 CREEDMOOR RD STE 104 | Raleigh, NC 27613-1711 | 919-518-0999 |
| MAILING | 1450 PROFESSIONAL PARK DR STE 150 | Winston Salem, NC 27103-1307 | 336-724-2434 |
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