The holder whose full name is Millard, Dan Fenton,come from Peoria IL,hold the Temporary MD Permit license(NO.99032937A) which status is Superceded.
| Name | Millard, Dan Fenton |
|---|---|
| License Number | 99032937A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Peoria |
| State | IL |