| NPI | 1750848644 |
|---|---|
| Doing Business As | LIBERTY SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Administrator 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |