{
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"OrgName": "BIOADVANCE PROSTHETIC SOLUTIONS, PLLC",
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"FirstLineMailingAddress": "1111 RAINTREE CIR",
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"FirstLinePracticeLocationAddress": "1111 RAINTREE CIR",
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"PracticeLocationAddressFaxNumber": "972-521-6102",
"EnumerationDate": "01/13/2016",
"LastUpdateDate": "11/02/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
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"AuthorizedOfficialMiddleName": "WAYNE",
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"AuthorizedOfficialCredential": "C.P.O., L.P",
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{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}