The holder whose full name is PAYNE, OTIS EDD,come from Lake Forest Park WA,hold the Physician license(NO.01034937A) which status is Expired Non-Renewable.
| Name | PAYNE, OTIS EDD |
|---|---|
| License Number | 01034937A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Lake Forest Park |
| State | WA |