The holder whose full name is LOPEZ, ALFONSO,come from PORTLAND IN,hold the Physician license(NO.01020564A) which status is Expired Non-Renewable.
| Name | LOPEZ, ALFONSO |
|---|---|
| License Number | 01020564A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | PORTLAND |
| State | IN |