The holder whose full name is LaClave, Alan J.,come from Avon IN,hold the CSR-Physician license(NO.01024400B) which status is Expired.
| Name | LaClave, Alan J. |
|---|---|
| License Number | 01024400B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Avon |
| State | IN |