ProviderBusinessMailingAddressFaxNumber = '3372618784'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1164961645
JIM
FREDERICKA
116 BERTRAND DR
LAFAYETTE
LA
705065632
1447626882
TERRACINA
CHARLES
200 ENERGY PKWY
LAFAYETTE
LA
705083816
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