Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 14, 2019
License(s)
2026-01982 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 108 DORNACH WAY | Advance, NC 27006-7305 | 336-940-2407 |
| LOCATION | 708 S SOUTH ST STE 100 | Mount Airy, NC 27030-4589 | 336-698-4055 |
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