Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jul 26, 2013
License(s)
021548-1 (NY), PA621 (WY), 021548-1 (NY), 085-009764 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 199 TOWN SQ STE A | Wheaton, IL 60189-3878 | 630-871-6690 |
| MAILING | PO BOX 713260 | Chicago, IL 60677-1260 | 630-469-9200 |
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