The holder whose full name is Mintz, Alfred Martin,come from OUT OF STATE IN,hold the CSR-Physician license(NO.01016035B) which status is Expired.
| Name | Mintz, Alfred Martin |
|---|---|
| License Number | 01016035B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | OUT OF STATE |
| State | IN |