Department of State
Board of Medicine
PREM FORT
Medical Physician And Surgeon
License number
MD440162
Date granted
05/26/2010
Date expires
12/31/2010
Class
Medical Physician And Surgeon
Status
Expired
Address
Tinton Falls NJ 07753
medicinepa.com
ID 37611372
LAST UPDATED 2024-04-20 16:54:10 UTC
LAST UPDATED 2024-04-20 16:54:10 UTC
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