The holder whose full name is Jacobsen, Karl Theodor,come from Coralville IA,hold the Health Facility Administrator license(NO.14003063A) which status is Expired.
| Name | Jacobsen, Karl Theodor |
|---|---|
| License Number | 14003063A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | Coralville |
| State | IA |