Indiana
Professional Licensing Agency
Fabiana Tan
Controlled Substance Registration - Physician
License number
01026625B
Date granted
07/01/1986
Date expires
06/30/2007
Class
Controlled Substance Registration - Physician
Status
Expired
Address
2515 Sycamore Hills Drive, Fort Wayne IN 46814
indianalicensing.org
ID 5853298
LAST UPDATED 2024-04-14 16:35:44 UTC
LAST UPDATED 2024-04-14 16:35:44 UTC
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