CHARLES RICHARD CANTRELL DO

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****95

NOT RENEWED

N

CHARLES

RICHARD

CANTRELL

DO

CHARLES RICHARD CANTRELL DO

09/21/1998

09/21/1998

07/31/2002

MOUNT VERNON

IL

62864

JEFFERSON

II III IV V

N

10/09/2006