| NPI | 1992884217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKS M TRAVIS Owner 573-443-0551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MO R8620) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MO 2002023835) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2009-08-17 |