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