The holder whose full name is BASA, AMELITA LOURDES,come from River Ridge LA,hold the Physician license(NO.01050479A) which status is Expired Non-Renewable.
| Name | BASA, AMELITA LOURDES |
|---|---|
| License Number | 01050479A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | River Ridge |
| State | LA |