The holder whose full name is WALLACE, COLLINS ROBERT,come from FT WAYNE IN,hold the Physician license(NO.01017787A) which status is Expired Non-Renewable.
| Name | WALLACE, COLLINS ROBERT |
|---|---|
| License Number | 01017787A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | FT WAYNE |
| State | IN |