{
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"FirstLineMailingAddress": "PO BOX 1685",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-949-5722",
"MailingAddressFaxNumber": "423-949-6176",
"FirstLinePracticeLocationAddress": "104 CATES ST",
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"EnumerationDate": "02/13/2006",
"LastUpdateDate": "09/02/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STANDEFER",
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"AuthorizedOfficialTelephoneNumber": "423-877-3568",
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{
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
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}
}