Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
May 22, 2013
License(s)
25MB09831400 (NJ), R0987 (TX), 268874 (NY), 268874 (NY), OS024771 (PA), 2025-01164 (NC), 345289 (LA), 3990 (AL), 16095 (ND), 103073 (GA), 22044 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1400 S MAIN ST STE 501 | Fort Worth, TX 76104-4909 | 817-702-8400 |
| LOCATION | 1400 S MAIN ST STE 501 | Fort Worth, TX 76104-4909 | 817-702-8400 |
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