The holder whose full name is ELLIS, FORREST JAMES,come from INDIANAPOLIS IN,hold the Medical Residency Permit license(NO.11005162A) which status is Expired.
| Name | ELLIS, FORREST JAMES |
|---|---|
| License Number | 11005162A |
| License Type | Medical Residency Permit |
| License Status | Expired |
| City | INDIANAPOLIS |
| State | IN |