Indiana
Professional Licensing Agency
Kiran Srirama
Controlled Substance Registration - Physician
License number
01052615B
Date granted
07/06/2000
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
TATUM FAMILY HEALTH CENTER, 1619 WEST 5TH AVENUE, Gary IN 46404
indianalicensing.org
ID 5856860
LAST UPDATED 2024-02-23 01:42:31 UTC
LAST UPDATED 2024-02-23 01:42:31 UTC
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