{
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"FirstLineMailingAddress": "1630 STREAM VALLEY OVERLOOK",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "410-305-0232",
"FirstLinePracticeLocationAddress": "KIMBROUGH AMBULATORY CARE CENTER",
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"EnumerationDate": "07/14/2006",
"LastUpdateDate": "04/26/2024",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}