LAUREN O PORTMAN DO

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****98

NOT RENEWED

N

LAUREN O

PORTMAN

DO

LAUREN O PORTMAN DO

04/02/1991

04/02/1991

07/31/1999

CHICAGO

IL

60611

COOK

II III IV V

N

09/26/2006