The holder whose full name is KELLY, MICHAEL T,come from Blaine WA,hold the Physician license(NO.01024829A) which status is Expired Non-Renewable.
| Name | KELLY, MICHAEL T |
|---|---|
| License Number | 01024829A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Blaine |
| State | WA |