NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1336770627
LEGACY'S IMPACT INTERVENTION L.L.C
3606 IDAHO AVE
BARTLESVILLE
OK
740062420
1538457569
CROWDER
SHONTA
YANETTE
PO BOX 3492
BARTLESVILLE
OK
740063492
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