The holder whose full name is HERNANDEZ, ILLUMINADA C,come from EAST CHICAGO IN,hold the Physician license(NO.01017900A) which status is Expired Non-Renewable.
| Name | HERNANDEZ, ILLUMINADA C |
|---|---|
| License Number | 01017900A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | EAST CHICAGO |
| State | IN |