The holder whose full name is Harley, Lisa Tamara,come from Fort Wayne IN,hold the CSR-Physician Assistant license(NO.10001309B) which status is Expired.
| Name | Harley, Lisa Tamara |
|---|---|
| License Number | 10001309B |
| License Type | CSR-Physician Assistant |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |