ProviderBusinessMailingAddressFaxNumber = '3185133612'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1285066886
JORDAN
TERRY
LEE
4396 HIGHWAY 80
RUSTON
LA
712708948
1831667104
VINCENT
LACY
CULVER
4396 HIGHWAY 80
RUSTON
LA
712708948
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