ProviderBusinessMailingAddressFaxNumber = '9185673917'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1861857229
HUMPHREYS
DOROTHEA
SHAUNA
1 CHOCTAW WAY
TALIHINA
OK
745712022
1407414600
LONG
KRISTIN
KATHLEEN
1 CHOCTAW WAY
TALIHINA
OK
74571
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