Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jun 5, 2009
License(s)
PA17077 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 512717 | Los Angeles, CA 90051-0717 | 310-967-1884 |
| LOCATION | 8700 BEVERLY BLVD | West Hollywood, CA 90048-1804 | 310-967-1884 |
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