The holder whose full name is Lewellen, Michael A.,come from Anderson IN,hold the Temporary PTA Permit license(NO.99021687A) which status is Superceded.
| Name | Lewellen, Michael A. |
|---|---|
| License Number | 99021687A |
| License Type | Temporary PTA Permit |
| License Status | Superceded |
| City | Anderson |
| State | IN |