| NPI | 1063680387 |
|---|---|
| Doing Business As | CHAMPION SPORTS MEDICINE - MONTCLAIR ROAD |
| Entity Type | Organization |
| Authorized Contact | JAYNE FLECK POOL Chief Compliance Officer 469-467-8705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2010-06-21 |