Indiana
Professional Licensing Agency
Johanna Henderson Wallisa
Medical Residency Permit
License number
11011999A
Date granted
05/17/2004
Date expires
06/30/2007
Class
Medical Residency Permit
Status
Superceded
Address
Westfield IN 46074
indianalicensing.org
ID 5998870
LAST UPDATED 2024-04-04 22:16:07 UTC
LAST UPDATED 2024-04-04 22:16:07 UTC
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