Directory of Immunization Coalitions
 
A project of the Immunization Action Coalition

  


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1.   How did you find out about this website?
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4.   Are you planning to, or have you, contacted any of the coalitions by using the information on this website?
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5.   Have you ever visited the Coalition’s parent website at www.immunize.org?

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Immunization Action Coalition
http://www.immunize.org
admin@immunize.org


IZ Coalitions
http://www.izcoalitions.org
admin@izcoalitions.org


1573 Selby Avenue, Ste. 234
St. Paul, MN 55104
Tel: (651) 647-9009   Fax: (651) 647-9131