{
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"FirstLineMailingAddress": "1800 HIGHWAY 95",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BULLHEAD CITY",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86442-6803",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-763-8443",
"MailingAddressFaxNumber": "928-763-3073",
"FirstLinePracticeLocationAddress": "1800 HIGHWAY 95",
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"PracticeLocationAddressCityName": "BULLHEAD CITY",
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"PracticeLocationAddressFaxNumber": "928-763-3073",
"EnumerationDate": "12/01/2006",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLESMANN",
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"AuthorizedOfficialTelephoneNumber": "928-763-8443",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Ambulatory Surgical Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}