The holder whose full name is Blake, Lou Ann,come from Shelbyville IN,hold the Preceptor Eligible license(NO.15002356A) which status is Expired.
| Name | Blake, Lou Ann |
|---|---|
| License Number | 15002356A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | Shelbyville |
| State | IN |