The holder whose full name is BROCHHAUSEN, PETER,come from SOUTH BEND IN,hold the Health Facility Administrator license(NO.14003152A) which status is Expired.
| Name | BROCHHAUSEN, PETER |
|---|---|
| License Number | 14003152A |
| License Type | Health Facility Administrator |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |