The holder whose full name is Wallisa, Johanna Henderson,come from Indianapolis IN,hold the CSR-Physician license(NO.01063488B) which status is Active.
| Name | Wallisa, Johanna Henderson |
|---|---|
| License Number | 01063488B |
| License Type | CSR-Physician |
| License Status | Active |
| City | Indianapolis |
| State | IN |