{
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"FirstLineMailingAddress": "11845 CRESTA VERDE DR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-997-5997",
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"FirstLinePracticeLocationAddress": "1034 S BRENTWOOD BLVD STE 1250",
"SecondLinePracticeLocationAddress": "FOREST PARK MEDICAL CLINIC",
"PracticeLocationAddressCityName": "ST,LOUIS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-367-6600",
"PracticeLocationAddressFaxNumber": "314-367-5982",
"EnumerationDate": "11/12/2010",
"LastUpdateDate": "11/12/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}