The holder whose full name is ZZZ06, Ima Test,come from Indianapolis IN,hold the Health Facility Administrator license(NO.14000000A) which status is Expired.
| Name | ZZZ06, Ima Test |
|---|---|
| License Number | 14000000A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | Indianapolis |
| State | IN |