| NPI | 1235601907 |
|---|---|
| Doing Business As | WCU SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Administrator/Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2018-12-19 |