The holder whose full name is Bagal, Amita Arun Manickam,come from Portage IN,hold the CSR-Physician license(NO.01056913C) which status is Expired.
| Name | Bagal, Amita Arun Manickam |
|---|---|
| License Number | 01056913C |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Portage |
| State | IN |