| NPI | 1780978502 |
|---|---|
| Doing Business As | SPORTY SPROUTS: YOUTH WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | BRANDON EUGENE HOLMES CEO 601-850-3698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |