The holder whose full name is Blough, Brian Eric,come from Granger IN,hold the CSR-Dentist license(NO.12009617B) which status is Expired.
| Name | Blough, Brian Eric |
|---|---|
| License Number | 12009617B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Granger |
| State | IN |