{
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"FirstLineMailingAddress": "911 MARYLAND AVE E # F3",
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "911 MARYLAND AVE E # F3",
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"EnumerationDate": "09/12/2019",
"LastUpdateDate": "05/28/2024",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "LY",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}