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MemberID
670404
LIC
NULL
HIN
NULL
Address
737 Heylman St
City
Fort Scott
STATE
KS
AssignmentStatus
NULL
Client
NULL

Affiliate

Territory
NULL
Website
NULL
RegionalSponsor
NULL
XetexCode
PR670404
SystemID
670403
ParentID
605082
CompanyCode
Premier, Inc

ClassOfTrade

Phone
(620) 223-1620
Fax
(620) 223-1621
x

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