The holder whose full name is MOORE, CARROLL W,come from BLOOMINGTON IN,hold the Preceptor Eligible license(NO.15000007A) which status is Expired.
| Name | MOORE, CARROLL W |
|---|---|
| License Number | 15000007A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | BLOOMINGTON |
| State | IN |