The holder whose full name is Miller, Lawrence Frederick,come from Granger IN,hold the Temporary MD Permit license(NO.99003047A) which status is Superceded.
| Name | Miller, Lawrence Frederick |
|---|---|
| License Number | 99003047A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Granger |
| State | IN |