Details as stated in the register
- DPOR board / occupation / certificate number
- 2705072358
- Source license rank
- C
- Source specialty codes
- LSC
- Source certification date
- 11/26/2002
- Source expiration date
- 11/30/2026
- Address city as filed
- EBONY
- Address state as filed
- VA
- Address ZIP as filed
- 23845
Register status and classifications are reproduced from the source. No independently verified business activity, customer premises, contact details, insurance or trade license is implied.