The holder whose full name is Black, Freda Ann,come from PORTAGE IN,hold the CSR-Prescriptive Authority license(NO.71001497B) which status is Current/Not Practicing.
| Name | Black, Freda Ann |
|---|---|
| License Number | 71001497B |
| License Type | CSR-Prescriptive Authority |
| License Status | Current/Not Practicing |
| City | PORTAGE |
| State | IN |