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"MailingAddressFaxNumber": "580-354-5544",
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"EnumerationDate": "01/11/2007",
"LastUpdateDate": "08/08/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SKIDGEL",
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"AuthorizedOfficialTelephoneNumber": "918-762-6611",
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{
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{
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},
{
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}
]
},
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}
}