{
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"FirstLineMailingAddress": "PO BOX 21890",
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"MailingAddressTelephoneNumber": "502-907-0356",
"MailingAddressFaxNumber": "502-919-9780",
"FirstLinePracticeLocationAddress": "7021 SAINT ANDREWS RD STE 1",
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"PracticeLocationAddressCityName": "COLUMBIA",
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"PracticeLocationAddressTelephoneNumber": "803-791-7175",
"PracticeLocationAddressFaxNumber": "802-791-7176",
"EnumerationDate": "01/30/2025",
"LastUpdateDate": "01/30/2025",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEWIS",
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"AuthorizedOfficialTelephoneNumber": "502-855-3919",
"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}