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Name:  WIXOM, JERRY LEE License Number:  5158
Alias: 
Address:  340 PEVERO DR
NPN:  2880897
  IDAHO FALLS, ID 83401-6321 Issued:  2/6/1979
    Expired:  7/31/2013
Business Phone:  (208) 524-5858 License Status: 
License Type: 
Inactive
Resident Surplus Lines Broker
Resident Producer
   


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