Indiana
Professional Licensing Agency
Anthereca Edmerson Lane
Controlled Substance Registration - Physician
License number
01063792B
Date granted
06/11/2007
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Fairhaven Obstetrics & Gynecology, Inc, 1111 Lighthouse Lane, Goshen IN 46526-3824
indianalicensing.org
ID 5858284
LAST UPDATED 2024-03-02 10:46:15 UTC
LAST UPDATED 2024-03-02 10:46:15 UTC
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