Indiana
Professional Licensing Agency
Camra Beth Faulkner
Controlled Substance Registration - Physician
License number
01074284B
Date granted
07/10/2014
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
965 Emerson Parkway, Suite J, Greenwood IN 46143
indianalicensing.org
ID 27707785
LAST UPDATED 2024-02-24 11:57:54 UTC
LAST UPDATED 2024-02-24 11:57:54 UTC
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