Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Mar 12, 2026
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 130 S PLYMOUTH AVE | Rochester, NY 14614-2209 | 800-245-7277 |
| MAILING | 3940 LOCUST LN | Harrisburg, PA 17109-4023 |
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