The holder whose full name is Ortiz, Juan Jose,come from Jeffersonville IN,hold the Temporary MD Permit license(NO.99003404A) which status is Superceded.
| Name | Ortiz, Juan Jose |
|---|---|
| License Number | 99003404A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Jeffersonville |
| State | IN |