The holder whose full name is Frederick, Mary Ann,come from Columbus IN,hold the Radiology Provisional Permit - Cardiac Catheterization license(NO.XP504468) which status is Superceded.
| Name | Frederick, Mary Ann |
|---|---|
| License Number | XP504468 |
| License Type | Radiology Provisional Permit - Cardiac Catheterization |
| License Status | Superceded |
| City | Columbus |
| State | IN |