The holder whose full name is Avila, John Rafael,come from MICHIGAN CITY IN,hold the CSR-Dentist license(NO.12009519C) which status is Expired.
| Name | Avila, John Rafael |
|---|---|
| License Number | 12009519C |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | MICHIGAN CITY |
| State | IN |