The holder whose full name is Boughaba, Dolly Albert,come from Covington KY,hold the Temporary MD Permit license(NO.99055115A) which status is Superceded.
| Name | Boughaba, Dolly Albert |
|---|---|
| License Number | 99055115A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Covington |
| State | KY |