| NPI | 1225312499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE RASMUSSEN Director Of Athletics 4042-280-2720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |