The holder whose full name is CUSACK, TERRENCE RANDALL,come from WABASH IN,hold the Physician Assistant license(NO.10000058A) which status is Expired.
| Name | CUSACK, TERRENCE RANDALL |
|---|---|
| License Number | 10000058A |
| License Type | Physician Assistant |
| License Status | Expired |
| City | WABASH |
| State | IN |