The holder whose full name is Fountain, Jeffrey Steven,come from Eden Prairie MN,hold the Temporary DO Permit license(NO.99062953A) which status is Superceded.
| Name | Fountain, Jeffrey Steven |
|---|---|
| License Number | 99062953A |
| License Type | Temporary DO Permit |
| License Status | Superceded |
| City | Eden Prairie |
| State | MN |