The holder whose full name is Blackmon, Amanda Marie,come from Kokomo IN,hold the CSR-Dentist license(NO.12011504B) which status is Expired.
| Name | Blackmon, Amanda Marie |
|---|---|
| License Number | 12011504B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Kokomo |
| State | IN |