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1184332405
JAKE EDWARD WEAVER
VINITA, OK
NPI
1184332405
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
Enumeration Date
2022-11-07
Last Update Date
2022-11-07
Business Address
JAKE EDWARD WEAVER
405 E EXCELSIOR AVE
VINITA, OK 74301-4226
Phone number: 918-256-6476
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Mailing Address
JAKE EDWARD WEAVER
405 E EXCELSIOR AVE
VINITA, OK 74301-4226
Phone number:
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