| NPI | 1548717119 |
|---|---|
| Doing Business As | JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 10954) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |