Indiana
Professional Licensing Agency
Diane E. Wallace
Controlled Substance Registration - Physician
License number
01061919B
Date granted
03/22/2006
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
371 St Andre Drive, Valparaiso IN 46383
indianalicensing.org
ID 5928434
LAST UPDATED 2024-03-29 15:49:21 UTC
LAST UPDATED 2024-03-29 15:49:21 UTC
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