FRED A BENJAMIN IV

JACKSON, TN
NPI1063404036
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy163W00000X Registered Nurse
(Licence: TN  RN0000085124)
Enumeration Date2005-08-16
Last Update Date2007-07-08
Business Address
-- FRED A BENJAMIN IV CRNA
36 BRENTSHIRE SQ
JACKSON, TN 38305-2245
Phone number: 731-664-1717
Mailing Address
-- FRED A BENJAMIN IV CRNA
70 STATE ROUTE 420
HUMBOLDT, TN 38343-5619
Phone number: 731-824-1939
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