The holder whose full name is Holzbog, Tracey D.,come from English IN,hold the Radiology Provisional Permit - Limited Medical Radiology license(NO.XP500741) which status is Superceded.
| Name | Holzbog, Tracey D. |
|---|---|
| License Number | XP500741 |
| License Type | Radiology Provisional Permit - Limited Medical Radiology |
| License Status | Superceded |
| City | English |
| State | IN |