The holder whose full name is Smith, Timothy Scott,come from South Bend IN,hold the Medical Residency Permit license(NO.11006012A) which status is Expired.
| Name | Smith, Timothy Scott |
|---|---|
| License Number | 11006012A |
| License Type | Medical Residency Permit |
| License Status | Expired |
| City | South Bend |
| State | IN |