The holder whose full name is Wallace, Catherine Lorene,come from Fort Wayne IN,hold the Student Temp RCP license(NO.99008927A) which status is Superceded.
| Name | Wallace, Catherine Lorene |
|---|---|
| License Number | 99008927A |
| License Type | Student Temp RCP |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |