{
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"FirstLineMailingAddress": "1160 S. DELLWOOD STREET",
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7691 CENTRAL AVE NE",
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"EnumerationDate": "05/20/2013",
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"NPIDeactivationDate": null,
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"GenderCode": null,
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"AuthorizedOfficialLastName": "FULTANG",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}