Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Nov 12, 2025
License(s)
RTL25-1305 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | PO BOX 138 | Fayetteville, NC 28302-0138 | 910-615-5095 |
| MAILING | 1707 OWEN DR | Fayetteville, NC 28304-3418 | 910-882-7315 |
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