Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
May 1, 2014
License(s)
MT205881 (PA), A145109 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 17360 BROOKHURST ST | Fountain Valley, CA 92708-3720 | 657-241-3592 |
| MAILING | 17360 BROOKHURST STREET ATTN: CREDENTIALING DEPARTMENT | Fountain Valley, CA 92708-3720 |
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