Organization
FRANCIS MARION UNIVERSITY
Active
Other names
FMU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
4822 E PALMETTO ST, FLORENCE, SC 29506-4530
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22677
SC
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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