ProviderBusinessMailingAddressFaxNumber = '5055525805'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1164517900
HUMPHRIES
LISA
R.
P.O. BOX 130
SAN FIDEL
NM
870490130
1164452207
SALEK
ROBERT
C
PO BOX 130
SAN FIDEL
NM
870490130
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