{
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"FirstLineMailingAddress": "6511 OSAGE AVE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-282-9304",
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"FirstLinePracticeLocationAddress": "348 LONG RAPIDS PLZ",
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"PracticeLocationAddressCityName": "ALPENA",
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"PracticeLocationAddressTelephoneNumber": "989-358-8086",
"PracticeLocationAddressFaxNumber": "989-354-2253",
"EnumerationDate": "04/21/2015",
"LastUpdateDate": "04/21/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERNST",
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"AuthorizedOfficialCredential": "OTRL",
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"Taxonomies": {
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}
},
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}
}