Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 3, 2006
License(s)
085-002123 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 3988 | Carbondale, IL 62902-3988 | 618-457-5200 |
| LOCATION | 2601 W MAIN ST | Carbondale, IL 62901-1031 | 618-549-5361 |
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