| NPI | 1538791538 |
|---|---|
| Doing Business As | BLOOMSBURG SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Administrator/Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2021-12-17 |