HOLLY MARLA FORMAN - Dietitian and Nutritionist License in Illinois | # 164002930

HOLLY MARLA FORMAN

Business Entity

NOT RENEWED

License Type

Dietitian and Nutritionist

Description

LICENSED DIETITIAN NUTRITIONIST

License Number

164002930

License Status

NOT RENEWED

Business

N

First Name

HOLLY MARLA

Last Name

FORMAN

Business Name

HOLLY MARLA FORMAN

Original Issue Date

12/19/1997

Expiration Date

10/31/2001

State

IL

Ever Disciplined

N

LastModifiedDate

09/11/2005