The holder whose full name is Fantauzzi, Mark R.,come from Fort Wayne IN,hold the CSR-Osteopathic Physician license(NO.02001815B) which status is Expired.
| Name | Fantauzzi, Mark R. |
|---|---|
| License Number | 02001815B |
| License Type | CSR-Osteopathic Physician |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |