The holder whose full name is Gaines-Thompson, Vivian L,come from Fort Wayne IN,hold the CSR-Prescriptive Authority license(NO.71004971B) which status is Active.
| Name | Gaines-Thompson, Vivian L |
|---|---|
| License Number | 71004971B |
| License Type | CSR-Prescriptive Authority |
| License Status | Active |
| City | Fort Wayne |
| State | IN |