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MemberID
53482
LIC
NULL
HIN
NULL
Address
1200 Hospital Dr Ste 4
Address2
NULL
City
Opelousas
STATE
LA
AssignmentStatus
NULL
Client
NULL

Affiliate

Territory
NULL
Website
NULL
RegionalSponsor
NULL
XetexCode
IN053482
SystemID
53482
ParentID
NULL
CompanyCode
Intalere

ClassOfTrade

Phone
+1.337.948.7090
Fax
+1.337.942.8108