| NPI | 1639898877 |
|---|---|
| Other Name | BIG MOUTH BASS CLINIC - SANDERSON TOWER - LEVEL B |
| Entity Type | Organization |
| Authorized Contact | JEFFREY GRIMSLEY CFO 601-815-6270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2024-05-01 |