{
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"FirstLineMailingAddress": "PO BOX 7412119",
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"MailingAddressCityName": "CHICAGO",
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"MailingAddressFaxNumber": "636-561-5100",
"FirstLinePracticeLocationAddress": "100 BREVCO PLZ",
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"PracticeLocationAddressFaxNumber": "636-561-5100",
"EnumerationDate": "02/17/2017",
"LastUpdateDate": "07/10/2025",
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"NPIReactivationDate": null,
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"Gender": null,
"AuthorizedOfficialLastName": "EGHIGIAN",
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"AuthorizedOfficialTelephoneNumber": "618-791-0975",
"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}