The holder whose full name is Shively, Amanda M,come from Fort Wayne IN,hold the Temporary PTA Permit license(NO.99008421A) which status is Superceded.
| Name | Shively, Amanda M |
|---|---|
| License Number | 99008421A |
| License Type | Temporary PTA Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |