| NPI | 1184007122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK THOMAS SPROUL Owner 276-238-0990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101254866) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |