Indiana
Professional Licensing Agency
Basman A Salous
Controlled Substance Registration - Physician
License number
01043104B
Date granted
10/14/1994
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Main Street Medical Group, 6913 North Main Street, Granger IN 46530
indianalicensing.org
ID 5859397
LAST UPDATED 2024-02-15 08:19:38 UTC
LAST UPDATED 2024-02-15 08:19:38 UTC
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