The holder whose full name is MILLER JR, WALLACE T,come from LAGRANGE IN,hold the Health Facility Administrator license(NO.14000071A) which status is Expired.
| Name | MILLER JR, WALLACE T |
|---|---|
| License Number | 14000071A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | LAGRANGE |
| State | IN |