NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1932689403
GREAT BASIN PAIN & WELLNESS LLC
PO BOX 2001
IDAHO FALLS
ID
834032001
1013974369
WING
RONNIE
JAY
660 S COOLIDGE ST
MOSES LAKE
WA
988371872
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