The holder whose full name is JOHNSON, GRANT CARL,come from SPRINGFIELD IL,hold the Physician license(NO.01014489A) which status is Expired Non-Renewable.
| Name | JOHNSON, GRANT CARL |
|---|---|
| License Number | 01014489A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | SPRINGFIELD |
| State | IL |