The holder whose full name is Tennenhouse, Derek Lewis,come from Mooresville IN,hold the CSR-Physician license(NO.01056104B) which status is Expired.
| Name | Tennenhouse, Derek Lewis |
|---|---|
| License Number | 01056104B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Mooresville |
| State | IN |