The holder whose full name is SHIPLEY, GARY DEAN,come from CROWN POINT IN,hold the CSR-Physician license(NO.01031550B) which status is Suspended.
| Name | SHIPLEY, GARY DEAN |
|---|---|
| License Number | 01031550B |
| License Type | CSR-Physician |
| License Status | Suspended |
| City | CROWN POINT |
| State | IN |