The holder whose full name is Kolasa, Mark Wayne,come from Universal City TX,hold the Physician license(NO.01059875A) which status is Expired Non-Renewable.
| Name | Kolasa, Mark Wayne |
|---|---|
| License Number | 01059875A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Universal City |
| State | TX |