Indiana
Professional Licensing Agency
Amanda S. Stack
Radiology Provisional Permit
License number
XP504864
Date granted
07/29/2013
Date expires
01/29/2014
Class
Radiology Provisional Permit
Status
Superceded
Address
Fort Wayne IN 46818
indianalicensing.org
ID 8490844
LAST UPDATED 2024-03-22 10:03:46 UTC
LAST UPDATED 2024-03-22 10:03:46 UTC
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