Indiana
Professional Licensing Agency
Mara Divis
Controlled Substance Registration-Osteopathic Physician
License number
02003631B
Date granted
08/23/2010
Date expires
10/31/2015
Class
Controlled Substance Registration-Osteopathic Physician
Status
Active
Address
Memorial Family Medicine, 714 N Michigan Street, South Bend IN 46601
indianalicensing.org
ID 5813509
LAST UPDATED 2024-05-14 18:23:28 UTC
LAST UPDATED 2024-05-14 18:23:28 UTC
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