The holder whose full name is LEWIS, ANITA MARIE,come from Portland IN,hold the CSR-Prescriptive Authority license(NO.71000578B) which status is Expired.
| Name | LEWIS, ANITA MARIE |
|---|---|
| License Number | 71000578B |
| License Type | CSR-Prescriptive Authority |
| License Status | Expired |
| City | Portland |
| State | IN |