The holder whose full name is Long, Tanya L.,come from Jeffersonville IN,hold the CSR-Dentist license(NO.12011588B) which status is Active.
| Name | Long, Tanya L. |
|---|---|
| License Number | 12011588B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Jeffersonville |
| State | IN |