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"FirstLineMailingAddress": "PO BOX 1068",
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"FirstLinePracticeLocationAddress": "18122 STATE ROUTE 9 SE",
"SecondLinePracticeLocationAddress": "SUITE I",
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"EnumerationDate": "06/09/2015",
"LastUpdateDate": "06/09/2015",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HANCOCK",
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"AuthorizedOfficialTelephoneNumber": "360-547-2286",
"Taxonomies": {
"Taxonomy": [
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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}
]
}
}
}