WALSTIR H FONSECA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

WALSTIR H

Last Name

FONSECA

Business Name

WALSTIR H FONSECA

Original Issue Date

09/09/1994

Effective Date

09/09/1994

Expiration Date

07/31/1996

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006