The holder whose full name is Fantauzzi, Mark R.,come from Portland ME,hold the Osteopathic Physician license(NO.02001815A) which status is Revoked.
| Name | Fantauzzi, Mark R. |
|---|---|
| License Number | 02001815A |
| License Type | Osteopathic Physician |
| License Status | Revoked |
| City | Portland |
| State | ME |