The holder whose full name is LaSalle, Angela Phyllis,come from Fort Wayne IN,hold the Medical Residency Permit license(NO.11007758A) which status is Expired.
| Name | LaSalle, Angela Phyllis |
|---|---|
| License Number | 11007758A |
| License Type | Medical Residency Permit |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |