WALSTIR H FONSECA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036088863

License Status

NOT RENEWED

Business

First Name

WALSTIR H

Last Name

FONSECA

Business Name

WALSTIR H FONSECA

Original Issue Date

07/05/1994

Effective Date

07/05/1994

Expiration Date

07/31/1996

City

SAVOY

State

Zip

61874

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/20/2006