FAIRBANK T CHUA

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****66

NOT RENEWED

N

FAIRBANK T

CHUA

FAIRBANK T CHUA

12/02/1982

12/02/1982

07/31/1987

CHICAGO

IL

60653

COOK

II III IV V

Y

09/26/2006

1983000185

Probation

11/05/1987