The holder whose full name is Boots, Carrie Jean,come from Fort Wayne IN,hold the CSR-Prescriptive Authority license(NO.71002416B) which status is Active.
| Name | Boots, Carrie Jean |
|---|---|
| License Number | 71002416B |
| License Type | CSR-Prescriptive Authority |
| License Status | Active |
| City | Fort Wayne |
| State | IN |