JAMES ERNEST PROVO
Controlled Substance Registration - Physician
Indiana 01039495B Expired
This Indiana license was held by JAMES ERNEST PROVO. The license is no longer active. It was granted on 08/02/1991 and expired on 06/30/1993
LICENSE DETAILS
- License Number: 01039495B
- Category: CSR-Physician
- Status: Expired
- Date Granted: 08/02/1991 (almost 34 years ago)
- Expiry Date: 06/30/1993 (almost 32 years ago)
LOCATIONS
A Address
MEMORIAL HOSPITAL, FIFTH & PINE STREETS, MICHIGAN CITY IN 46360