{
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"FirstLineMailingAddress": "5208 BRYANT IRVIN RD",
"SecondLineMailingAddress": "SUITE 3143",
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"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76132-3826",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "805 HILL BLVD",
"SecondLinePracticeLocationAddress": "SUITE 106",
"PracticeLocationAddressCityName": "GRANBURY",
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"PracticeLocationAddressTelephoneNumber": "817-579-7770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/04/2010",
"LastUpdateDate": "06/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NADER",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "724-971-9717",
"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}