ProviderBusinessMailingAddressFaxNumber = '2602039187'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1588061592
COLLINGSWORTH
MELISSA
5904 E STATE BLVD
FORT WAYNE
IN
468157637
1487983037
REDWINE
CHARLES
PHILIP
126 W COLUMBIA ST
FORT WAYNE
IN
468021719
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