The holder whose full name is LAKE, CLIFTON BLAINE,come from LOUISVILLE KY,hold the Preceptor Eligible license(NO.15004371A) which status is Expired.
| Name | LAKE, CLIFTON BLAINE |
|---|---|
| License Number | 15004371A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | LOUISVILLE |
| State | KY |