The holder whose full name is Koltash, Mark Judson,come from Fort Wayne IN,hold the Health Facility Administrator license(NO.14004939A) which status is Active.
| Name | Koltash, Mark Judson |
|---|---|
| License Number | 14004939A |
| License Type | Health Facility Administrator |
| License Status | Active |
| City | Fort Wayne |
| State | IN |