Indiana
Professional Licensing Agency
Mary W. Martin
Controlled Substance Registration - Physician
License number
01053527B
Date granted
03/20/2001
Date expires
06/30/2005
Class
Controlled Substance Registration - Physician
Status
Expired
Address
7111 Forest Avenue, Hammond IN 46324
indianalicensing.org
ID 5864636
LAST UPDATED 2024-03-15 16:25:47 UTC
LAST UPDATED 2024-03-15 16:25:47 UTC
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