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DHMH : cdssearch: M06243

CDSPERMIT

M06243

APPLICANT_NAME

A GIBSON PACKARD

APPLICANT_STATUS

CANCELLED

CLASSIFICATION

PRACTITIONER

ADRESS

7302 WAVERLY ISLAND RD

CITY

EASTON

COUNTY

 

ZIP

21601

STATE

MD

ADDRESS2

 

PROFESSION

MD

LICENSE_ISSUEDDATE

7/1/1995 12:00 AM

LICENSE_EXPDATE

6/30/1997 12:00 AM

CURR_CERTIFICATION

Y

Attachments

Created at 11/21/2013 11:55 AM by System Account
Last modified at 11/21/2013 11:55 AM by System Account