{
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"FirstLineMailingAddress": "PO BOX 720855",
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"EnumerationDate": "02/01/2006",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "SPEIGHTS",
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"AuthorizedOfficialCredential": "P.T.",
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{
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{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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},
{
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}
]
}
}
}