The holder whose full name is Lichten, Edward Mark,come from Plainfield IN,hold the CSR-Physician license(NO.01070877B) which status is Active.
| Name | Lichten, Edward Mark |
|---|---|
| License Number | 01070877B |
| License Type | CSR-Physician |
| License Status | Active |
| City | Plainfield |
| State | IN |