The holder whose full name is Lackey, Diana Lynn,come from Fort Wayne IN,hold the Temporary MD Permit license(NO.99027845A) which status is Superceded.
| Name | Lackey, Diana Lynn |
|---|---|
| License Number | 99027845A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |