The holder whose full name is LAKE, JON PETER,come from EFFINGHAM IL,hold the Physician license(NO.01038252A) which status is Expired Non-Renewable.
| Name | LAKE, JON PETER |
|---|---|
| License Number | 01038252A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | EFFINGHAM |
| State | IL |