Kenneth A. Black
Controlled Substance Registration - Physician
Indiana 01024841B Active
This Indiana license is held by Kenneth A. Black. The license is currently active. It was granted on 07/31/1986 and expired on 10/31/2015
LICENSE DETAILS
- License Number: 01024841B
- Category: CSR-Physician
- Status: Active
- Date Granted: 07/31/1986 (over 38 years ago)
- Expiry Date: 10/31/2015 (over 9 years ago)
LOCATIONS
A Address
3630 Willowcreek Road, Portage IN 46368
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