Deborah S.I. Provisor
Controlled Substance Registration - Physician
Indiana 01024413B Expired
This Indiana license was held by Deborah S.I. Provisor. The license is no longer active. It was granted on 03/31/1986 and expired on 06/30/1997
LICENSE DETAILS
- License Number: 01024413B
- Category: CSR-Physician
- Status: Expired
- Date Granted: 03/31/1986 (about 39 years ago)
- Expiry Date: 06/30/1997 (almost 28 years ago)
LOCATIONS
A Address
P O BOX 40407, 1707 WEST 86TH STREET, INDIANAPOLIS IN 46240