The holder whose full name is ELLIS, DAVID LEE,come from WABASH IN,hold the CSR-Physician license(NO.01021805B) which status is Expired.
| Name | ELLIS, DAVID LEE |
|---|---|
| License Number | 01021805B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | WABASH |
| State | IN |