Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jun 14, 2005
License(s)
9701679 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1911 S 17TH ST STE 130-A | Wilmington, NC 28401-6662 | 910-790-7840 |
| MAILING | 1911 S 17TH ST SUITE 130A | Wilmington, NC 28401-6662 | 910-790-7840 |
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