The holder whose full name is Ponugoti, Ajay,come from Greenwood IN,hold the CSR-Physician license(NO.01058162B) which status is Active.
| Name | Ponugoti, Ajay |
|---|---|
| License Number | 01058162B |
| License Type | CSR-Physician |
| License Status | Active |
| City | Greenwood |
| State | IN |