The holder whose full name is Teubert, Carrie J.,come from Fort Wayne IN,hold the Radiology Provisional Permit - Cardiac Catheterization license(NO.XP505556) which status is Superceded.
| Name | Teubert, Carrie J. |
|---|---|
| License Number | XP505556 |
| License Type | Radiology Provisional Permit - Cardiac Catheterization |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |