The holder whose full name is Maddox, Douglas R.,come from La Porte IN,hold the Temporary PTA Permit license(NO.99021852A) which status is Superceded.
| Name | Maddox, Douglas R. |
|---|---|
| License Number | 99021852A |
| License Type | Temporary PTA Permit |
| License Status | Superceded |
| City | La Porte |
| State | IN |