The holder whose full name is Lilly, Mary Luanne,come from Fort Defiance AZ,hold the CSR-Prescriptive Authority license(NO.70000096B) which status is Expired.
| Name | Lilly, Mary Luanne |
|---|---|
| License Number | 70000096B |
| License Type | CSR-Prescriptive Authority |
| License Status | Expired |
| City | Fort Defiance |
| State | AZ |