Indiana
Professional Licensing Agency
Mallory N. Gillam
Radiology Provisional Permit
License number
XP504530
Date granted
02/12/2013
Date expires
08/12/2013
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Tipton IN 46072
indianalicensing.org
ID 8495697
LAST UPDATED 2024-02-08 22:07:51 UTC
LAST UPDATED 2024-02-08 22:07:51 UTC
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