Indiana
Professional Licensing Agency
Andrea Russell
Radiology Provisional Permit
License number
XP504923
Date granted
08/26/2013
Date expires
02/26/2014
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Fort Wayne IN 46806
indianalicensing.org
ID 8490851
LAST UPDATED 2024-03-25 18:20:03 UTC
LAST UPDATED 2024-03-25 18:20:03 UTC
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