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"FirstLineMailingAddress": "826 E 12300 S STE 2",
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"FirstLinePracticeLocationAddress": "7611 S JORDAN LANDING BLVD STE 120&130",
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"EnumerationDate": "05/07/2019",
"LastUpdateDate": "05/07/2019",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "BLACKETT",
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"AuthorizedOfficialCredential": "CPM, LDEM",
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}
},
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}
}
}
}