Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 24, 2007
License(s)
012120 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 5645 MAIN ST | Flushing, NY 11355-5045 | 718-661-7267 |
| MAILING | 5645 MAIN ST | Flushing, NY 11355-5045 | 718-661-7267 |
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