The holder whose full name is BENNETT, CARMEN LORETTA,come from QUEENS NY,hold the Physician license(NO.01033847A) which status is Revoked.
| Name | BENNETT, CARMEN LORETTA |
|---|---|
| License Number | 01033847A |
| License Type | Physician |
| License Status | Revoked |
| City | QUEENS |
| State | NY |