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Record Last Updated: 2026-04-05
| License / Permit / Certification Number | 22 |
| Registration Number | - |
| License / Permit / Certification Status | REVOKED |
| License Type | FIRM |
| Basis for License | - |
| Issue Date | 1961-06-30 |
| Expiration Date | - |
Enforcement, Non-Compliance or Disciplinary Actions | Contact State Board for Details |
| Other Information | None |