The holder whose full name is Walter, Tiya A.,come from Garrett IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS004379) which status is Superceded.
| Name | Walter, Tiya A. |
|---|---|
| License Number | XS004379 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Superceded |
| City | Garrett |
| State | IN |