{
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"FirstLineMailingAddress": "PO BOX 6342",
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"FirstLinePracticeLocationAddress": "983 RESERVE DR",
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"EnumerationDate": "01/20/2016",
"LastUpdateDate": "01/22/2016",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOLBERT",
"AuthorizedOfficialFirstName": "CHARLES",
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"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}