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1124459862
BENJAMIN FONSECA
CHARLOTTE, NC
NPI
1124459862
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NC 1814)
Enumeration Date
2013-12-05
Last Update Date
2013-12-05
Business Address
-- BENJAMIN FONSECA
10318 GLENBURN LN
CHARLOTTE, NC 28278-6005
Phone number: 704-906-8095
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Mailing Address
-- BENJAMIN FONSECA
10318 GLENBURN LN
CHARLOTTE, NC 28278-6005
Phone number: 704-906-8095
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