| NPI | 1366991523 |
|---|---|
| Doing Business As | JACKSON STATE UNIVERSITY SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 09707) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2016-09-29 |