License Number: DN14745Data As Of 6/2/2020
|License Expiration Date||2/28/2022|
|License Original Issue Date||01/09/1998|
|Address of Record||385 DOUGLAS AVE|
|ALTAMONTE SPRINGS, FL 32714|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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