{
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"FirstLineMailingAddress": "500 S SWEET GUM AVE",
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"FirstLinePracticeLocationAddress": "4815 S HARVARD AVE STE 428",
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"EnumerationDate": "03/01/2016",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "BLACK",
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}
},
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}
}