Indiana
Professional Licensing Agency
Wylie Craig de Vera
Controlled Substance Registration - Physician
License number
01071947B
Date granted
05/13/2013
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
MedExpress, 1010 S Reed Road, Kokomo IN 46901
indianalicensing.org
ID 5877562
LAST UPDATED 2024-02-23 15:20:47 UTC
LAST UPDATED 2024-02-23 15:20:47 UTC
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