| NPI | 1285264531 |
|---|---|
| Doing Business As | ETSU SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Administrator/Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2021-12-17 |