Mary Ellen Black
Controlled Substance Registration - Physician
Indiana 01042492B Expired
This Indiana license was held by Mary Ellen Black. The license is no longer active. It was granted on 05/26/1994 and expired on 06/30/1995
LICENSE DETAILS
- License Number: 01042492B
- Category: CSR-Physician
- Status: Expired
- Date Granted: 05/26/1994 (over 32 years ago)
- Expiry Date: 06/30/1995 (about 31 years ago)
LOCATIONS
A Address
2400 EAST 17 TH STREET, COLUMBUS IN 47201