BENNIE CARROL BLAKE
Physician
Indiana 01027504A Expired Non-Renewable
This Indiana license was held by BENNIE CARROL BLAKE. The license is no longer active. It was granted on 03/01/1977 and expired on 06/30/2005
LICENSE DETAILS
- License Number: 01027504A
- Category: Physician
- Status: Expired Non-Renewable
- Date Granted: 03/01/1977 (over 47 years ago)
- Expiry Date: 06/30/2005 (almost 19 years ago)
LOCATIONS
A Address
VALPARAISO IN 46383