Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
May 16, 2007
License(s)
304480 (NY), 01070961A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 5001 US HIGHWAY 30 W STE D | Fort Wayne, IN 46818-9701 | 260-432-1568 |
| MAILING | PO BOX 80070 | Fort Wayne, IN 46898-0070 | 260-432-1568 |
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