Indiana
Professional Licensing Agency
Juan Martin Favetto
Controlled Substance Registration - Physician
License number
01051584B
Date granted
10/25/1999
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Connie Lewellyn, 3605 Northgate Ct #105, New Albany IN 47150
indianalicensing.org
ID 5902995
LAST UPDATED 2024-02-29 15:26:47 UTC
LAST UPDATED 2024-02-29 15:26:47 UTC
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