The holder whose full name is AMAYA, CARLOS ERNESTO,come from SHELBYVILLE IN,hold the CSR-Physician license(NO.01021607B) which status is Suspended.
| Name | AMAYA, CARLOS ERNESTO |
|---|---|
| License Number | 01021607B |
| License Type | CSR-Physician |
| License Status | Suspended |
| City | SHELBYVILLE |
| State | IN |