License Type:
Medical Doctor
License Number:
4301079891
Name:
Susan Grace Moore
License Issue Date:
05/27/2005
License Expiration Date:
01/31/2021
License Status:
Lapsed
County:
Non-Michigan County
City:
Flint
State or Province:
Michigan
ZIP or Postal Code:
48532
CS Record Number:
5315009935
CS Status:
CS Expiration Date:
06/30/2005
Carmel
Indiana
46032
5315022667