The holder whose full name is Balcitis, Tabitha Renee,come from Crown Point IN,hold the Student Temp RCP license(NO.99033066A) which status is Superceded.
| Name | Balcitis, Tabitha Renee |
|---|---|
| License Number | 99033066A |
| License Type | Student Temp RCP |
| License Status | Superceded |
| City | Crown Point |
| State | IN |