2974 Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED PHYSICIAN

License Number

002020174-0002

License Status

NOT RENEWED

Business

Last Name

2974

Business Name

2974

Original Issue Date

01/14/1976

Effective Date

01/14/1976

Expiration Date

01/14/1977

City

LASALLE

State

Zip

61301

County

LA SALLE

Ever Disciplined

LastModifiedDate

09/18/2006