Indiana
Professional Licensing Agency
TaQuilla J. Black
Radiology Provisional Permit
License number
XP502527
Date granted
05/05/2010
Date expires
11/05/2010
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Fort Wayne IN 46806-3426
indianalicensing.org
ID 8491049
LAST UPDATED 2024-03-17 03:10:05 UTC
LAST UPDATED 2024-03-17 03:10:05 UTC
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