Indiana
Professional Licensing Agency
Kenneth D. Petersen
Controlled Substance Registration - Physician
License number
01028273B
Date granted
07/31/1986
Date expires
10/31/2013
Class
Controlled Substance Registration - Physician
Status
Expired
Address
Fairhaven Obstetrics & Gynecology, 1111 Lighthouse Lane, Goshen IN 46526-3824
indianalicensing.org
ID 5858797
LAST UPDATED 2024-04-12 07:38:32 UTC
LAST UPDATED 2024-04-12 07:38:32 UTC
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