Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Sep 15, 2008
License(s)
0110008678 (VA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 22239 | New York, NY 10087-0001 | 702-899-0595 |
| LOCATION | 2425 25TH ST SE | Washington, DC 20020-3409 | 872-231-3162 |
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