The holder whose full name is George, Antony Velikagathote,come from Elmwood Park IL,hold the Temporary MD Permit license(NO.99040901A) which status is Superceded.
| Name | George, Antony Velikagathote |
|---|---|
| License Number | 99040901A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Elmwood Park |
| State | IL |