The holder whose full name is Park, Kathryn Laura,come from South Bend IN,hold the Temporary MD Permit license(NO.99003689A) which status is Superceded.
| Name | Park, Kathryn Laura |
|---|---|
| License Number | 99003689A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | South Bend |
| State | IN |