{
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"FirstLineMailingAddress": "4011 S MONROE MEDICAL PARK BLVD",
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"MailingAddressCityName": "BLOOMINGTON",
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"MailingAddressTelephoneNumber": "812-825-1111",
"MailingAddressFaxNumber": "812-825-0782",
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"EnumerationDate": "07/11/2006",
"LastUpdateDate": "05/16/2013",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "URBAN",
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}
},
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}
}