{
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"FirstLineMailingAddress": "PO BOX 230622",
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"MailingAddressTelephoneNumber": "307-699-3213",
"MailingAddressFaxNumber": "907-802-4450",
"FirstLinePracticeLocationAddress": "7216 LAKE OTIS PKWY",
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"EnumerationDate": "12/13/2017",
"LastUpdateDate": "05/22/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WRIGHT",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}