The holder whose full name is Moon, Jared Lee,come from Portage IN,hold the Podiatrist Temporary Permit license(NO.99053018A) which status is Superceded.
| Name | Moon, Jared Lee |
|---|---|
| License Number | 99053018A |
| License Type | Podiatrist Temporary Permit |
| License Status | Superceded |
| City | Portage |
| State | IN |