{
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"FirstLineMailingAddress": "4000 N ILLINOIS LN",
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"MailingAddressFaxNumber": "618-236-1299",
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"EnumerationDate": "06/23/2006",
"LastUpdateDate": "07/18/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUSMANO",
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"AuthorizedOfficialTitle": "VICE PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "182-575-6076",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}