The holder whose full name is COPPOLA, CARL DAVID,come from New Albany IN,hold the CSR-Physician license(NO.01040346B) which status is Expired.
| Name | COPPOLA, CARL DAVID |
|---|---|
| License Number | 01040346B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | New Albany |
| State | IN |