The holder whose full name is Atala, Anthony John,come from SCOTTSBURG IN,hold the CSR-Physician license(NO.01036552B) which status is Expired.
| Name | Atala, Anthony John |
|---|---|
| License Number | 01036552B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | SCOTTSBURG |
| State | IN |