Indiana
Professional Licensing Agency
James E. Wack
Controlled Substance Registration - Physician
License number
01017207B
Date granted
09/30/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
52670 Brookdale Drive, South Bend IN 46637
indianalicensing.org
ID 5921153
LAST UPDATED 2024-03-13 06:35:42 UTC
LAST UPDATED 2024-03-13 06:35:42 UTC
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