The holder whose full name is Howard, Benjamin Wallace,come from West Des Moines IA,hold the Medical Residency Permit license(NO.11017923A) which status is Active.
| Name | Howard, Benjamin Wallace |
|---|---|
| License Number | 11017923A |
| License Type | Medical Residency Permit |
| License Status | Active |
| City | West Des Moines |
| State | IA |