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1407578891
JACK WHITE
COOS BAY, OR
NPI
1407578891
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: OR 22-CRM-1099)
Enumeration Date
2022-09-13
Last Update Date
2022-09-13
Business Address
JACK WHITE CRM , THW
1741 NEWMARK AVE
COOS BAY, OR 97420-4704
Phone number: 541-851-7151
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Mailing Address
JACK WHITE CRM , THW
155 S EMPIRE BLVD
COOS BAY, OR 97420-3374
Phone number: 541-851-7151
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