Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 7, 2022
License(s)
125080503 (IL), R-12699 (IA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 200 HAWKINS DR | Iowa City, IA 52242-1009 | 319-356-1694 |
| MAILING | 200 HAWKINS DR | Iowa City, IA 52242-1009 | 319-356-1694 |
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