| NPI | 1871003301 |
|---|---|
| Doing Business As | SEMO STATE SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2007008844) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2021-12-17 |