The holder whose full name is IMLAY, DONNA J.,come from GAS CITY IN,hold the Preceptor Eligible license(NO.15002479A) which status is Expired.
| Name | IMLAY, DONNA J. |
|---|---|
| License Number | 15002479A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | GAS CITY |
| State | IN |