The holder whose full name is KELLY, DIANE D.,come from FORT WAYNE IN,hold the Health Facility Administrator license(NO.14001191A) which status is Expired.
| Name | KELLY, DIANE D. |
|---|---|
| License Number | 14001191A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | FORT WAYNE |
| State | IN |