The holder whose full name is Baines, Colleen Ann,come from Lafayette IN,hold the CSR-Dentist license(NO.12010256B) which status is Active.
| Name | Baines, Colleen Ann |
|---|---|
| License Number | 12010256B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Lafayette |
| State | IN |