ProviderBusinessMailingAddressFaxNumber = '8032762630'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1013266949
LONG
ELMER
GORDON
1410 WILSON RD
NEWBERRY
SC
291083050
1881741890
REDMOND
SHAKISHA
T
1818 HENDERSON ST
COLUMBIA
SC
292012619
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