MemberID
613815
LIC
NULL
HIN
NULL
Address
127 E Redstone Ave
Address2
Ste C
City
Crestview
STATE
FL
AssignmentStatus
Open
Account
NULL
Client
NULL
Territory
NULL
Website
NULL
RegionalSponsor
NULL
XetexCode
PR613815
SystemID
IL9040
ParentID
IL9039
CompanyCode
Premier, Inc