The holder whose full name is LONG, KEITH JAMES,come from TRAVERSE CITY MI,hold the Physician license(NO.01016961A) which status is Expired Non-Renewable.
| Name | LONG, KEITH JAMES |
|---|---|
| License Number | 01016961A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | TRAVERSE CITY |
| State | MI |