The holder whose full name is SHAW, EDWARD R,come from BLOOMINGTON IN,hold the Health Facility Administrator license(NO.14001568A) which status is Expired.
| Name | SHAW, EDWARD R |
|---|---|
| License Number | 14001568A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | BLOOMINGTON |
| State | IN |