The holder whose full name is BALLES, MARK WILSON,come from PORTLAND ME,hold the Physician license(NO.01042207A) which status is Expired Non-Renewable.
| Name | BALLES, MARK WILSON |
|---|---|
| License Number | 01042207A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | PORTLAND |
| State | ME |