{
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"FirstLineMailingAddress": "24944 HWY 15",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "769-222-1078",
"FirstLinePracticeLocationAddress": "24944 HWY 15",
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"EnumerationDate": "04/10/2017",
"LastUpdateDate": "07/22/2020",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "QUINN",
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"AuthorizedOfficialCredential": "PHARM D",
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{
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},
{
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},
{
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}
]
},
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}
}