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1649508334
BENTON REAL STOUT
RIVERSIDE, CA
NPI
1649508334
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CA PA20699)
Enumeration Date
2009-11-18
Last Update Date
2009-11-18
Business Address
-- BENTON REAL STOUT Physician Assistant
1850 SPRING GARDEN ST
RIVERSIDE, CA 92507-2050
Phone number: 951-544-9589
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Mailing Address
-- BENTON REAL STOUT Physician Assistant
1850 SPRING GARDEN ST
RIVERSIDE, CA 92507-2050
Phone number: 951-544-9589
Copy
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