{
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"FirstLineMailingAddress": "PO BOX 50720",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AMARILLO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79159-0720",
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"MailingAddressFaxNumber": "806-355-1284",
"FirstLinePracticeLocationAddress": "205 EAST LLANO ESTACADO BLVD.",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "CLOVIS",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressTelephoneNumber": "806-353-0125",
"PracticeLocationAddressFaxNumber": "806-355-0834",
"EnumerationDate": "02/06/2015",
"LastUpdateDate": "12/28/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARPENTER",
"AuthorizedOfficialFirstName": "CAROL",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "806-467-0459",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}