The holder whose full name is Rutherford, Elizabeth Ann Ellis,come from Beverly Shores IN,hold the Temporary MD Permit license(NO.99009191A) which status is Superceded.
| Name | Rutherford, Elizabeth Ann Ellis |
|---|---|
| License Number | 99009191A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Beverly Shores |
| State | IN |