HAROLD W GOFORTH

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****72

NOT RENEWED

N

HAROLD

W

GOFORTH

HAROLD W GOFORTH

10/29/2001

10/29/2001

07/31/2005

MAYWOOD

IL

60153

COOK

II III IV V

N

10/09/2006