The holder whose full name is Black, Barbara Ann,come from Churubusco IN,hold the Dental Hygienist license(NO.13003124A) which status is Expired.
| Name | Black, Barbara Ann |
|---|---|
| License Number | 13003124A |
| License Type | Dental Hygienist |
| License Status | Expired |
| City | Churubusco |
| State | IN |