The holder whose full name is Burgess, Latasha M.,come from Gary IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS001630) which status is Expired Non-Renewable.
| Name | Burgess, Latasha M. |
|---|---|
| License Number | XS001630 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Expired Non-Renewable |
| City | Gary |
| State | IN |