The holder whose full name is Houltberg, Benjamin James,come from Fort Wayne IN,hold the Temp Marr & Fam Ther Permit license(NO.99048594A) which status is Superceded.
| Name | Houltberg, Benjamin James |
|---|---|
| License Number | 99048594A |
| License Type | Temp Marr & Fam Ther Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |