The holder whose full name is CHANTELOIS, ALLEN EDWARD,come from Indianapolis IN,hold the CSR-Physician license(NO.01054439B) which status is Expired.
| Name | CHANTELOIS, ALLEN EDWARD |
|---|---|
| License Number | 01054439B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Indianapolis |
| State | IN |