The holder whose full name is Jefferson, Theodore B.,come from Mokena IL,hold the Temporary MD Permit license(NO.99039197A) which status is Superceded.
| Name | Jefferson, Theodore B. |
|---|---|
| License Number | 99039197A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Mokena |
| State | IL |