NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1124325006
PRIME
JEREMY
PAUL
 
1512 W KIRBY PL
SHREVEPORT
LA
711033822
1225442254
RAMADAS
POORNIMA
 
 
1512 W KIRBY PL
SHREVEPORT
LA
711033822
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