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"FirstLineMailingAddress": "PO BOX 15607",
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"MailingAddressCityName": "ARLINGTON",
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"MailingAddressPostalCode": "22215-0607",
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"MailingAddressTelephoneNumber": "571-309-9768",
"MailingAddressFaxNumber": "888-356-1032",
"FirstLinePracticeLocationAddress": "10332 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE #344",
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"PracticeLocationAddressFaxNumber": "301-782-9929",
"EnumerationDate": "06/30/2015",
"LastUpdateDate": "09/02/2016",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "HALL",
"AuthorizedOfficialFirstName": "DALTON",
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"Taxonomies": {
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"TaxonomyName": "Surgical Physician Assistant",
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}
},
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}
}
}
}