{
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "5340 S QUEBEC ST",
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"EnumerationDate": "10/04/2012",
"LastUpdateDate": "12/31/2012",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREEN",
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"AuthorizedOfficialTelephoneNumber": "703-564-1653",
"Taxonomies": {
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}
},
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}
}