Registry details
Type
Individual
Primary specialty
Ophthalmology
Enumerated
Aug 3, 2016
License(s)
P33497 (MD), 84015 (SC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 171 ASHLEY AVE | Charleston, SC 29425-5201 | 843-792-1414 |
| MAILING | PO BOX 751461 | Charlotte, NC 28275-1461 | 843-792-6200 |
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