The holder whose full name is Lopez, Mary Edith,come from Fort Wayne IN,hold the CSR-Prescriptive Authority license(NO.71004898B) which status is Active.
| Name | Lopez, Mary Edith |
|---|---|
| License Number | 71004898B |
| License Type | CSR-Prescriptive Authority |
| License Status | Active |
| City | Fort Wayne |
| State | IN |