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Individual
MRS. ISIS BURAKOM RUTLEDGE
Active
Individual
MRS. ISIS BURAKOM RUTLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
4969
CO
171W00000X
Contractor
Primary
68684
CA
Other
Enumeration date
04/09/2009
Last updated
10/11/2016
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