The holder whose full name is Banghart, Britt Leanne,come from Fort Wayne IN,hold the Student Temp RCP license(NO.99054248A) which status is Superceded.
| Name | Banghart, Britt Leanne |
|---|---|
| License Number | 99054248A |
| License Type | Student Temp RCP |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |