The holder whose full name is Fong, Alexander Eric,come from Shawnee KS,hold the Temporary MD Permit license(NO.99060564A) which status is Superceded.
| Name | Fong, Alexander Eric |
|---|---|
| License Number | 99060564A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Shawnee |
| State | KS |