The holder whose full name is BLACK, MARJORIE JANE,come from PLAINFIELD IN,hold the Health Facility Administrator license(NO.14002425A) which status is Expired.
| Name | BLACK, MARJORIE JANE |
|---|---|
| License Number | 14002425A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | PLAINFIELD |
| State | IN |