Details as stated in the register
- DPOR board / occupation / certificate number
- 2705087829
- Source license rank
- B
- Source specialty codes
- CIC HIC
- Source certification date
- 08/16/2004
- Source expiration date
- 08/31/2028
- Address city as filed
- VIRGINIA BEACH
- Address state as filed
- VA
- Address ZIP as filed
- 23454
Register status and classifications are reproduced from the source. No independently verified business activity, customer premises, contact details, insurance or trade license is implied.