The holder whose full name is Ponton, Fred J,come from Bloomington IN,hold the Preceptor Eligible license(NO.15000620A) which status is Expired.
| Name | Ponton, Fred J |
|---|---|
| License Number | 15000620A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | Bloomington |
| State | IN |