The holder whose full name is Bricking, Keith Douglas,come from Indianapolis IN,hold the Physician license(NO.01057806A) which status is Expired Non-Renewable.
| Name | Bricking, Keith Douglas |
|---|---|
| License Number | 01057806A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Indianapolis |
| State | IN |