The holder whose full name is ROTH, JOAN LUCKEY,come from FORT WAYNE IN,hold the Health Facility Administrator license(NO.14000490A) which status is Expired.
| Name | ROTH, JOAN LUCKEY |
|---|---|
| License Number | 14000490A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | FORT WAYNE |
| State | IN |