The holder whose full name is CLARK, ALAN DALE,come from OUT OF STATE GA,hold the CSR-Physician license(NO.01036493B) which status is Expired.
| Name | CLARK, ALAN DALE |
|---|---|
| License Number | 01036493B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | OUT OF STATE |
| State | GA |