Detail by Officer/Registered Agent Name

Florida Profit Corporation

CRESTVIEW MEDICAL CLINIC LABORATORY, INC.

Filing Information
K77706 59-2947432 03/29/1989 FL INACTIVE VOLUNTARY DISSOLUTION 12/30/1991 NONE
Principal Address
% JAMES L. CHASE
101 EAST GOVERNMENT ST.
PENSACOLA, FL 32501
Mailing Address
% JAMES L. CHASE
101 EAST GOVERNMENT ST.
PENSACOLA, FL 32501
Registered Agent Name & Address CHASE, JAMES L.
101 EAST GOVERNMENT AVE.
PENSACOLA, FL 32501
Name Changed: 04/25/1990

Address Changed: 04/25/1990
Officer/Director Detail Name & Address

Title D

CAMPBELL, WAYNE E. M.D.
130 REDSTONE AVE.
CRESTVIEW, FL
Title D

CAMPBELL, DAVID M. M.D.
130 REDSTONE AVE.
CRESTVIEW, FL
Title D

THIGPEN, R. LEE M.D.
130 REDSTONE AVE.
CRESTVIEW, FL
Title D

JOHNSON, JOHN T.
130 REDSTONE AVE.
CRESTVIEW, FL
Title P

SMITH, RICK E., R.T.
130 REDSTONE AVENUE
CRESTVIEW, FL
Title V

PANGLE, GARY W., M.T.
130 REDSTONE AVENUE
CRESTVIEW, FL
Annual Reports
Report YearFiled Date
1990 04/25/1990
1991 04/12/1991

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