Indiana
Professional Licensing Agency
Summit Pediatric and Adolescent Center, PC
Medical Licensing Board - Medical Corporation
License number
50004762A
Date granted
11/04/2005
Date expires
01/31/2008
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
1011 Ivy Creek Cove, Fort Wayne IN 46804
indianalicensing.org
ID 24827027
LAST UPDATED 2026-05-08 14:34:16 UTC
LAST UPDATED 2026-05-08 14:34:16 UTC
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