The holder whose full name is Lewis, Jason Talmadge,come from Brentwood TN,hold the Temporary MD Permit license(NO.99056718A) which status is Superceded.
| Name | Lewis, Jason Talmadge |
|---|---|
| License Number | 99056718A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Brentwood |
| State | TN |