{
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"FirstLineMailingAddress": "205 DONNALLY ST",
"SecondLineMailingAddress": null,
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"MailingAddressCountryCode": "US",
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"EnumerationDate": "07/22/2011",
"LastUpdateDate": "07/22/2011",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREEMAN",
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"Taxonomies": {
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"LicenseNumber": "1916971",
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}
},
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}
}