T000103 | ASC gov

Active

Inactive

Effective Date of Credential

Mon, 11/16/1992 - 12:00

Expiration Date of Credential

Mon, 11/15/1993 - 12:00

Conforms to AQB

No

ID

240161

Certification Type

Transitional License

Address

20665 SW BASELINE ROAD

City

BEAVERTON

State/Province

OR

Zip

97006

County

WASHINGTON

State