Mark Adrian Lake
Controlled Substance Registration - Physician
Indiana 01055166B Active
This Indiana license is held by Mark Adrian Lake. The license is currently active. It was granted on 10/18/2001 and expired on 10/31/2015
LICENSE DETAILS
- License Number: 01055166B
- Category: CSR-Physician
- Status: Active
- Date Granted: 10/18/2001 (over 23 years ago)
- Expiry Date: 10/31/2015 (over 9 years ago)
LOCATIONS
A Address
15 Executive Drive Suite 4, Lafayette IN 47905
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