Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Dec 1, 2017
License(s)
2017-02390 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 100 KIMEL FOREST DR | Winston Salem, NC 27103-6074 | 336-716-0238 |
| LOCATION | 4618 COUNTRY CLUB RD | Winston Salem, NC 27104-3520 | 367-163-9263 |
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