Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 24, 2011
License(s)
0010-02725 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1074 SOUTHERN AVE | Fayetteville, NC 28306-1766 | 910-221-1590 |
| MAILING | 1074 SOUTHERN AVE | Fayetteville, NC 28306-1766 | 910-221-1590 |
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