The holder whose full name is Booth, Marc A,come from West Lafayette IN,hold the Medical Residency Permit license(NO.11009102A) which status is Superceded.
| Name | Booth, Marc A |
|---|---|
| License Number | 11009102A |
| License Type | Medical Residency Permit |
| License Status | Superceded |
| City | West Lafayette |
| State | IN |