The holder whose full name is Mallik, Balwant Singh,come from Madison IN,hold the CSR-Physician license(NO.01029914C) which status is Expired.
| Name | Mallik, Balwant Singh |
|---|---|
| License Number | 01029914C |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Madison |
| State | IN |