The holder whose full name is Underwood, Ellen Nicole,come from Fort Wayne IN,hold the CSR-Prescriptive Authority license(NO.71001268C) which status is Active.
| Name | Underwood, Ellen Nicole |
|---|---|
| License Number | 71001268C |
| License Type | CSR-Prescriptive Authority |
| License Status | Active |
| City | Fort Wayne |
| State | IN |