The holder whose full name is Henry, Alvin L.,come from COLUMBUS IN,hold the CSR-Physician license(NO.01014630B) which status is Expired.
| Name | Henry, Alvin L. |
|---|---|
| License Number | 01014630B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | COLUMBUS |
| State | IN |