The holder whose full name is Harris, Charles Robert,come from New Lenox IL,hold the Temporary MD Permit license(NO.99038735A) which status is Superceded.
| Name | Harris, Charles Robert |
|---|---|
| License Number | 99038735A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | New Lenox |
| State | IL |