The holder whose full name is Hicks, Brooks Glenn,come from La Grange KY,hold the Temporary MD Permit license(NO.99010600A) which status is Superceded.
| Name | Hicks, Brooks Glenn |
|---|---|
| License Number | 99010600A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | La Grange |
| State | KY |