The holder whose full name is KRUSE SUSSER, LAWRENCE A,come from BLOOMINGTON IN,hold the CSR-Physician license(NO.01040883B) which status is Expired.
| Name | KRUSE SUSSER, LAWRENCE A |
|---|---|
| License Number | 01040883B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | BLOOMINGTON |
| State | IN |