{
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"FirstLineMailingAddress": "PO BOX 818",
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"MailingAddressCityName": "PACIFIC CITY",
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"MailingAddressTelephoneNumber": "503-965-0014",
"MailingAddressFaxNumber": "503-965-3637",
"FirstLinePracticeLocationAddress": "38505 BROOTEN RD",
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"EnumerationDate": "06/10/2016",
"LastUpdateDate": "06/10/2016",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}