GAYLIN D LACK MD SC Medical Corporation License verification

Business Entity

NOT RENEWED

License Type

Medical Corporation

Description

REGISTERED MEDICAL CORPORATION

License Number

042005455

License Status

NOT RENEWED

Business

Business Name

GAYLIN D LACK MD SC

Original Issue Date

08/22/1983

Effective Date

08/22/1983

Expiration Date

01/01/2004

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

10/09/2006