The holder whose full name is Destefano, Diane Lynn,come from Mount Carmel IL,hold the CSR-Prescriptive Authority license(NO.71003775B) which status is Expired.
| Name | Destefano, Diane Lynn |
|---|---|
| License Number | 71003775B |
| License Type | CSR-Prescriptive Authority |
| License Status | Expired |
| City | Mount Carmel |
| State | IL |