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1902612740
KENNETH MARLON JACKSON
BATON ROUGE, LA
NPI
1902612740
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172A00000X Driver
(Licence: LA 002515859)
Enumeration Date
2024-12-06
Last Update Date
2024-12-06
Business Address
KENNETH MARLON JACKSON
8630 ANTIOCH RD
BATON ROUGE, LA 70817-6413
Phone number: 504-667-8133
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Mailing Address
KENNETH MARLON JACKSON
8630 ANTIOCH RD
BATON ROUGE, LA 70817-6413
Phone number: 504-667-8133
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