The holder whose full name is Hernandez, Antonio Medalla,come from Indianapolis IN,hold the CSR-Physician license(NO.01050006B) which status is Expired.
| Name | Hernandez, Antonio Medalla |
|---|---|
| License Number | 01050006B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Indianapolis |
| State | IN |