{
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"FirstLineMailingAddress": "PO BOX 3592",
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"MailingAddressFaxNumber": "662-842-7915",
"FirstLinePracticeLocationAddress": "200 KNIGHT DR RM 230",
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"PracticeLocationAddressCityName": "SALTILLO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-840-0535",
"PracticeLocationAddressFaxNumber": "628-427-9156",
"EnumerationDate": "09/19/2019",
"LastUpdateDate": "06/22/2021",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}