The holder whose full name is MILLER, WALLACE T SR,come from WARSAW IN,hold the Health Facility Administrator license(NO.14000076A) which status is Expired.
| Name | MILLER, WALLACE T SR |
|---|---|
| License Number | 14000076A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | WARSAW |
| State | IN |