The holder whose full name is LEWIS, LUCIEN ANTHONY,come from GARY IN,hold the CSR-Physician license(NO.01019203B) which status is Expired.
| Name | LEWIS, LUCIEN ANTHONY |
|---|---|
| License Number | 01019203B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | GARY |
| State | IN |