{
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"FirstLineMailingAddress": "1503 N LOGAN AVE",
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"MailingAddressStateName": "IL",
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"FirstLinePracticeLocationAddress": "1900 E MAIN ST",
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"EnumerationDate": "07/10/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
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}
},
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}
}