ProviderBusinessMailingAddressFaxNumber = '7654282505'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1114245958
FENNELL
ELLY
JO
3900 ST FRANCIS WAY STE 205
LAFAYETTE
IN
479054939
1851353106
SCHMIDT
DAVID
R
1116 N 16TH ST
LAFAYETTE
IN
479042119
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