The holder whose full name is Lewis, Juanita Louise,come from Gary IN,hold the Temporary RCP Permit license(NO.99011856A) which status is Superceded.
| Name | Lewis, Juanita Louise |
|---|---|
| License Number | 99011856A |
| License Type | Temporary RCP Permit |
| License Status | Superceded |
| City | Gary |
| State | IN |