{
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"FirstLineMailingAddress": "1906 BROADWAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VANCOUVER",
"MailingAddressStateName": "WA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "360-694-9531",
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"PracticeLocationAddressFaxNumber": "360-694-9531",
"EnumerationDate": "01/18/2012",
"LastUpdateDate": "01/18/2012",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PREVEC",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "ANDREW",
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"AuthorizedOfficialCredential": "LAC, LMP",
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"Taxonomies": {
"Taxonomy": {
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}