{
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"FirstLineMailingAddress": "1747 SMIZER STATION RD",
"SecondLineMailingAddress": "SUITE 6",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-225-7908",
"MailingAddressFaxNumber": "636-225-7497",
"FirstLinePracticeLocationAddress": "1747 SMIZER STATION RD",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "636-225-7497",
"EnumerationDate": "06/25/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REICHARDT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "636-225-7908",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}