Indiana
Professional Licensing Agency
DENISE LYTTIE JACKSON
Controlled Substance Registration - Physician
License number
01045164B
Date granted
05/23/1996
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
7905 CALUMET AVE, MUNSTER IN 46321
indianalicensing.org
ID 5900097
LAST UPDATED 2024-04-23 13:48:22 UTC
LAST UPDATED 2024-04-23 13:48:22 UTC
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