The holder whose full name is Mallasch, Kelly M.,come from New Whiteland IN,hold the Radiology Provisional Permit - Podiatric Radiography license(NO.XP500034) which status is Superceded.
| Name | Mallasch, Kelly M. |
|---|---|
| License Number | XP500034 |
| License Type | Radiology Provisional Permit - Podiatric Radiography |
| License Status | Superceded |
| City | New Whiteland |
| State | IN |