BENNIE CARROL BLAKE
Controlled Substance Registration - Physician
Indiana 01027504B Expired
This Indiana license was held by BENNIE CARROL BLAKE. The license is no longer active. It was granted on 12/31/1985 and expired on 06/30/2005
LICENSE DETAILS
- License Number: 01027504B
- Category: CSR-Physician
- Status: Expired
- Date Granted: 12/31/1985 (over 38 years ago)
- Expiry Date: 06/30/2005 (almost 19 years ago)
LOCATIONS
A Address
1101 EAST GLENDALE BOULEVARD, VALPARAISO IN 46383