Indiana
Professional Licensing Agency
Jess Bruce Wagner
Controlled Substance Registration - Physician
License number
01050647B
Date granted
05/14/1999
Date expires
06/30/2005
Class
Controlled Substance Registration - Physician
Status
Expired
Address
661 Meadow Lark Lane, Bloomington IN 47408
indianalicensing.org
ID 5824809
LAST UPDATED 2024-04-01 12:39:44 UTC
LAST UPDATED 2024-04-01 12:39:44 UTC
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