Indiana
Professional Licensing Agency
Amanda Marie Dornfeld
Controlled Substance Registration - Physician
License number
01059524B
Date granted
09/13/2004
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Sandcrest Family Medicine, 3202 Middle Road, Columbus IN 47203
indianalicensing.org
ID 5835750
LAST UPDATED 2024-04-01 12:55:19 UTC
LAST UPDATED 2024-04-01 12:55:19 UTC
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