The holder whose full name is Thackery, Tara M.,come from Rushville IN,hold the Radiology Provisional Permit - Limited Medical Radiology license(NO.XP500149) which status is Expired Non-Renewable.
| Name | Thackery, Tara M. |
|---|---|
| License Number | XP500149 |
| License Type | Radiology Provisional Permit - Limited Medical Radiology |
| License Status | Expired Non-Renewable |
| City | Rushville |
| State | IN |