The holder whose full name is Blackburn, James William,come from Evansville IN,hold the Dental Intern Permit license(NO.42000154A) which status is Expired.
| Name | Blackburn, James William |
|---|---|
| License Number | 42000154A |
| License Type | Dental Intern Permit |
| License Status | Expired |
| City | Evansville |
| State | IN |