The holder whose full name is Banayan, Koorosh,come from EAST CHICAGO IN,hold the CSR-Physician license(NO.01034835B) which status is Expired.
| Name | Banayan, Koorosh |
|---|---|
| License Number | 01034835B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | EAST CHICAGO |
| State | IN |