The holder whose full name is Fulk, Douglas Leusby,come from Carbondale IL,hold the Physician license(NO.01061611A) which status is Expired Non-Renewable.
| Name | Fulk, Douglas Leusby |
|---|---|
| License Number | 01061611A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Carbondale |
| State | IL |