The holder whose full name is BALLARD, DANIEL JOHN,come from Chicago IL,hold the Temporary MD Permit license(NO.99003339A) which status is Superceded.
| Name | BALLARD, DANIEL JOHN |
|---|---|
| License Number | 99003339A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Chicago |
| State | IL |