The holder whose full name is LASA JR, JUAN M,come from WESTVILLE IN,hold the Physician license(NO.01042885A) which status is Expired Non-Renewable.
| Name | LASA JR, JUAN M |
|---|---|
| License Number | 01042885A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | WESTVILLE |
| State | IN |