{
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"FirstLineMailingAddress": "804 GULF STREET",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "804 GULF STREET",
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"EnumerationDate": "12/13/2021",
"LastUpdateDate": "12/21/2021",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "REAVLEY",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}