The holder whose full name is Asencio, Alida,come from South Sioux City NE,hold the Temporary MD Permit license(NO.99004592A) which status is Superceded.
| Name | Asencio, Alida |
|---|---|
| License Number | 99004592A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | South Sioux City |
| State | NE |