The holder whose full name is Wallace, Christi Ann,come from Fort Wayne IN,hold the Medical Residency Permit license(NO.11016226A) which status is Superceded.
| Name | Wallace, Christi Ann |
|---|---|
| License Number | 11016226A |
| License Type | Medical Residency Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |