The holder whose full name is FORD, JACKIE,come from BLOOMINGTON IN,hold the Health Facility Administrator license(NO.14002404A) which status is Expired.
| Name | FORD, JACKIE |
|---|---|
| License Number | 14002404A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | BLOOMINGTON |
| State | IN |