LARRY SCOTT DENCKLAU DO

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****99

NOT RENEWED

N

LARRY

SCOTT

DENCKLAU

DO

LARRY SCOTT DENCKLAU DO

12/28/2004

12/28/2004

07/31/2008

OLYMPIA FIELDS

IL

60461

COOK

II III IV V

N

11/06/2008