The holder whose full name is Liepert, Douglas Robert,come from South Bend IN,hold the CSR-Physician license(NO.01068512B) which status is Active.
| Name | Liepert, Douglas Robert |
|---|---|
| License Number | 01068512B |
| License Type | CSR-Physician |
| License Status | Active |
| City | South Bend |
| State | IN |