The holder whose full name is Blackwell, Derrick Lewis,come from Fort Mill SC,hold the Temporary DO Permit license(NO.99048997A) which status is Superceded.
| Name | Blackwell, Derrick Lewis |
|---|---|
| License Number | 99048997A |
| License Type | Temporary DO Permit |
| License Status | Superceded |
| City | Fort Mill |
| State | SC |