The holder whose full name is KIRTLAN, BONITA JEAN,come from WABASH IN,hold the Health Facility Administrator license(NO.14003819A) which status is Expired.
| Name | KIRTLAN, BONITA JEAN |
|---|---|
| License Number | 14003819A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | WABASH |
| State | IN |