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MemberID
31417
LIC
NULL
HIN
NULL
Address
814 S Washington Ave.Ste. A
Address2
266
City
Titusville
STATE
FL
AssignmentStatus
Tentative
Client
ICG
Territory
NULL
XetexCode
FC31417
SystemID
NULL
ParentID
NULL
CompanyCode
First Choice Cooperative
Phone
3212684767