ProviderBusinessMailingAddressFaxNumber = '5094883348'
NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1003002403
LOPEZ
TAMMY
A
 
361 E MAIN ST
OTHELLO
WA
993441055
1154403707
SIMMONS
ROBERT
M.
 
361 E MAIN ST
OTHELLO
WA
993441055
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