{
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"FirstLineMailingAddress": "18532 TWISTED OAK CT",
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"FirstLinePracticeLocationAddress": "7641 HALL STREET ROAD",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "NORTH CHESTERFIELD",
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"EnumerationDate": "02/15/2023",
"LastUpdateDate": "11/09/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SWANN",
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"AuthorizedOfficialCredential": "QMHP-C",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}