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1306379169
JACKSON SPENCER
MOSCOW, ID
NPI
1306379169
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
Enumeration Date
2017-04-09
Last Update Date
2017-04-09
Business Address
-- JACKSON SPENCER
627 KENNETH ST
MOSCOW, ID 83843-3904
Phone number: 208-310-3255
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Mailing Address
-- JACKSON SPENCER
627 KENNETH ST
MOSCOW, ID 83843-3904
Phone number:
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