The holder whose full name is LONG, ALBOURNE,come from SOUTH BEND IN,hold the CSR-Dentist license(NO.12004800B) which status is Expired.
| Name | LONG, ALBOURNE |
|---|---|
| License Number | 12004800B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |