The holder whose full name is VILLANUEVA, JOHNGALEN TAMAYO,come from BLACKSTONE VA,hold the Physician license(NO.01052112A) which status is Expired Non-Renewable.
| Name | VILLANUEVA, JOHNGALEN TAMAYO |
|---|---|
| License Number | 01052112A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | BLACKSTONE |
| State | VA |