| NPI | 1518400191 |
|---|---|
| Doing Business As | FC SPORTS AND THERAPY CENTER |
| Entity Type | Organization |
| Authorized Contact | MIKE BOLEWARE Administrator 601-384-8126 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |