The holder whose full name is Blackburn, Bruce A.,come from Kokomo IN,hold the CSR-Dentist license(NO.12007761B) which status is Active.
| Name | Blackburn, Bruce A. |
|---|---|
| License Number | 12007761B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Kokomo |
| State | IN |