The holder whose full name is BASS, ANDORA LYNN,come from Louisville KY,hold the Temporary MD Permit license(NO.99003643A) which status is Superceded.
Name | BASS, ANDORA LYNN |
---|---|
License Number | 99003643A |
License Type | Temporary MD Permit |
License Status | Superceded |
City | Louisville |
State | KY |