The holder whose full name is POLOMSKEY, DELORES J,come from SOUTH BEND IN,hold the Preceptor Eligible license(NO.15001384A) which status is Expired.
| Name | POLOMSKEY, DELORES J |
|---|---|
| License Number | 15001384A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |