The holder whose full name is Blackburn, Jay Howard,come from La Porte IN,hold the Dentist license(NO.12008954A) which status is Expired.
| Name | Blackburn, Jay Howard |
|---|---|
| License Number | 12008954A |
| License Type | Dentist |
| License Status | Expired |
| City | La Porte |
| State | IN |