License Detail

number94103
last_nameABRAHAM
first_nameALBERT
middle_nameB.
address1103 Polaris Drive
cityYORKTOWN
stateVA
zip23693
expire_date6/30/2016
date_granted7/22/2004
work_phone757 373 1775
branch1ELE
StatusACT

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