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1659871796
JODY MACK BROUSSARD
DERIDDER, LA
NPI
1659871796
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172A00000X Driver
(Licence: LA 005855942)
Enumeration Date
2018-02-15
Last Update Date
2018-02-15
Business Address
JODY MACK BROUSSARD
494 OTTO FRANKLIN RD
DERIDDER, LA 70634-6404
Phone number: 337-396-1312
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Mailing Address
JODY MACK BROUSSARD
494 OTTO FRANKLIN RD
DERIDDER, LA 70634-6404
Phone number: 337-396-1312
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