The holder whose full name is CUSTODIO, ALEXANDER O,come from MUNSTER IN,hold the Physician license(NO.01022707A) which status is Revoked.
| Name | CUSTODIO, ALEXANDER O |
|---|---|
| License Number | 01022707A |
| License Type | Physician |
| License Status | Revoked |
| City | MUNSTER |
| State | IN |