| NPI | 1376263293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONI KEMP WEEKS Administrative Assistant 662-615-2504 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2022-09-01 |