The holder whose full name is Phillips, Betty Rose,come from Fort Wayne IN,hold the CSR-Prescriptive Authority license(NO.71000072B) which status is Expired.
| Name | Phillips, Betty Rose |
|---|---|
| License Number | 71000072B |
| License Type | CSR-Prescriptive Authority |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |