| NPI | 1962891556 |
|---|---|
| Doing Business As | CLAYTON STATE SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 1800-555-9073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |