Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 10, 2007
License(s)
2007013148 (MO), MD427190 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 2450 W HUNTING PARK AVE | Philadelphia, PA 19129-1302 | 215-707-7237 |
| LOCATION | 3401 N BROAD ST | Philadelphia, PA 19140-5103 | 215-707-7237 |
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