Podiatrist

LICENSED PODIATRY CONTROLLED SUBSTANCE

31*****72

NOT RENEWED

N

ANTHONY V

DE CEANNE

DPM

ANTHONY V DE CEANNE DPM

04/19/1993

04/19/1993

01/31/2001

PEKIN

IL

61554

TAZEWELL

II III IV V

N

10/09/2006