The holder whose full name is Blackburn, Dwight Leroy,come from Louisville KY,hold the Physician license(NO.01049205A) which status is Expired Non-Renewable.
| Name | Blackburn, Dwight Leroy |
|---|---|
| License Number | 01049205A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Louisville |
| State | KY |