The holder whose full name is EISAMAN, JACK L,come from COLUMBIA CITY IN,hold the Physician license(NO.01013174A) which status is Expired Non-Renewable.
| Name | EISAMAN, JACK L |
|---|---|
| License Number | 01013174A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | COLUMBIA CITY |
| State | IN |