Indiana
Professional Licensing Agency
Jack Prow Clark
Controlled Substance Registration - Physician
License number
01017687B
Date granted
11/30/1986
Date expires
06/30/2011
Class
Controlled Substance Registration - Physician
Status
Expired
Address
518 EMS D15 Lane, Syracuse IN 46567
indianalicensing.org
ID 5923818
LAST UPDATED 2024-04-21 23:36:13 UTC
LAST UPDATED 2024-04-21 23:36:13 UTC
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