{
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"FirstLineMailingAddress": "58725 BATES RD",
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"FirstLinePracticeLocationAddress": "21885 DUNHAM RD STE 7",
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"EnumerationDate": "07/13/2018",
"LastUpdateDate": "03/02/2021",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "FOSS",
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"AuthorizedOfficialCredential": "BSW LLBSW",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}