| NPI | 1902357379 |
|---|---|
| Doing Business As | MISSOURI SOUTHERN STATE UNIVERSITY SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 112693) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |