The holder whose full name is Kacak, Loan Thi Phuong,come from Hammond IN,hold the Provisional Esthetician license(NO.ESP1100001) which status is Superceded.
| Name | Kacak, Loan Thi Phuong |
|---|---|
| License Number | ESP1100001 |
| License Type | Provisional Esthetician |
| License Status | Superceded |
| City | Hammond |
| State | IN |