The holder whose full name is Blevins, Harold W.,come from Louisville KY,hold the Temporary MD Permit license(NO.99001431A) which status is Superceded.
| Name | Blevins, Harold W. |
|---|---|
| License Number | 99001431A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Louisville |
| State | KY |