The holder whose full name is Jackson, Tara R.,come from Merrillville IN,hold the Radiology Provisional Permit - Podiatric Radiography license(NO.XP504197) which status is Superceded.
| Name | Jackson, Tara R. |
|---|---|
| License Number | XP504197 |
| License Type | Radiology Provisional Permit - Podiatric Radiography |
| License Status | Superceded |
| City | Merrillville |
| State | IN |