The holder whose full name is De Villiers, Miriam,come from Fort Wayne IN,hold the Temp Marr & Fam Ther Permit license(NO.99007326A) which status is Superceded.
| Name | De Villiers, Miriam |
|---|---|
| License Number | 99007326A |
| License Type | Temp Marr & Fam Ther Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |