The holder whose full name is Blume, Tina M.,come from Mishawaka IN,hold the Radiology Provisional Permit - Podiatric Radiography license(NO.XP501883) which status is Superceded.
| Name | Blume, Tina M. |
|---|---|
| License Number | XP501883 |
| License Type | Radiology Provisional Permit - Podiatric Radiography |
| License Status | Superceded |
| City | Mishawaka |
| State | IN |