The holder whose full name is Davis, Jan Ellen,come from West Lafayette IN,hold the CSR-Prescriptive Authority license(NO.72000023B) which status is Active.
| Name | Davis, Jan Ellen |
|---|---|
| License Number | 72000023B |
| License Type | CSR-Prescriptive Authority |
| License Status | Active |
| City | West Lafayette |
| State | IN |