The holder whose full name is Lewis, Berry Everett,come from Chicago IL,hold the Temporary MD Permit license(NO.99016526A) which status is Superceded.
| Name | Lewis, Berry Everett |
|---|---|
| License Number | 99016526A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Chicago |
| State | IL |