The holder whose full name is INGALLS, JERRY M,come from CLINTON IN,hold the CSR-Physician license(NO.01030834B) which status is Expired.
| Name | INGALLS, JERRY M |
|---|---|
| License Number | 01030834B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | CLINTON |
| State | IN |