The holder whose full name is Bali, Marissa K.,come from South Bend IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS006409) which status is Superceded.
| Name | Bali, Marissa K. |
|---|---|
| License Number | XS006409 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Superceded |
| City | South Bend |
| State | IN |