BENJAMIN ALEXANDER BLACK

WILLOW BROOK, IL
NPI1699751396
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL  96002214)
Enumeration Date2005-12-15
Last Update Date2007-07-08
Business Address
-- BENJAMIN ALEXANDER BLACK ATC
207 63RD ST ATHLETICO
WILLOW BROOK, IL 60527-2147
Phone number: 630-230-0900
Mailing Address
-- BENJAMIN ALEXANDER BLACK ATC
220 LINCOLN OAKS DR APT. 1413
WILLOW BROOK, IL 60527-3271
Phone number: 630-768-8556
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