The holder whose full name is Medina, Frenando L.,come from Decatur IN,hold the CSR-Physician license(NO.01048383B) which status is Expired.
| Name | Medina, Frenando L. |
|---|---|
| License Number | 01048383B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Decatur |
| State | IN |