The holder whose full name is Fern, Amanda Marie,come from University Place WA,hold the Medical Residency Permit license(NO.11014587A) which status is Superceded.
| Name | Fern, Amanda Marie |
|---|---|
| License Number | 11014587A |
| License Type | Medical Residency Permit |
| License Status | Superceded |
| City | University Place |
| State | WA |