| NPI | 1124383377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY BENNETT Owner 662-418-4675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |