ProviderBusinessMailingAddressFaxNumber = '8593590739'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1346808615
POORE
KELVIN
1974 WALTON NICHOLSON PIKE
INDEPENDENCE
KY
410517906
1235738105
THOMPSON
DEMETRIUS
1974 WALTON NICHOLSON PIKE
INDEPENDENCE
KY
410517906
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