The holder whose full name is RUBY, ALLAN,come from SOUTH BEND IN,hold the CSR-Physician license(NO.01042840B) which status is Expired.
| Name | RUBY, ALLAN |
|---|---|
| License Number | 01042840B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |