Indiana
Professional Licensing Agency
Tanya Roberts
Controlled Substance Registration - Physician
License number
01059615B
Date granted
08/09/2004
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Lake Ridge Clinic, 1573 N. Cline Ave., Griffith IN 46319
indianalicensing.org
ID 5863117
LAST UPDATED 2024-02-15 04:08:52 UTC
LAST UPDATED 2024-02-15 04:08:52 UTC
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