The holder whose full name is AMBROSE, KEITH NELSON,come from FORT WAYNE IN,hold the Health Facility Administrator license(NO.14002916A) which status is Expired.
| Name | AMBROSE, KEITH NELSON |
|---|---|
| License Number | 14002916A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | FORT WAYNE |
| State | IN |