The holder whose full name is Back, Lia Camile,come from Blackey KY,hold the Physician Assistant license(NO.10001743A) which status is Active.
| Name | Back, Lia Camile |
|---|---|
| License Number | 10001743A |
| License Type | Physician Assistant |
| License Status | Active |
| City | Blackey |
| State | KY |