{
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"FirstLineMailingAddress": "PO BOX 1958",
"SecondLineMailingAddress": "32382 PINE MANOR LANE",
"MailingAddressCityName": "RUNNING SPRINGS",
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"FirstLinePracticeLocationAddress": "12980 FREDERICK ST STE I",
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"PracticeLocationAddressCityName": "MORENO VALLEY",
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"PracticeLocationAddressTelephoneNumber": "951-924-3244",
"PracticeLocationAddressFaxNumber": "951-243-6976",
"EnumerationDate": "09/14/2006",
"LastUpdateDate": "07/08/2007",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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"TaxonomyName": "Physician Assistant",
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}
},
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}
}