The holder whose full name is GATMAITAN, ALFONSO W,come from TIPTON IN,hold the Health Facility Administrator license(NO.14003756A) which status is Expired.
| Name | GATMAITAN, ALFONSO W |
|---|---|
| License Number | 14003756A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | TIPTON |
| State | IN |