JERRAD LEE BENTON

SAINT LOUIS, MO
NPI1891211017
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225700000X Massage Therapist
(Licence: MO  2001031193)
Enumeration Date2017-08-18
Last Update Date2022-07-21
Business Address
Mr. JERRAD LEE BENTON LMT, MMP
2430 TELLICHERRY DR
SAINT LOUIS, MO 63125-3108
Phone number: 314-600-6293
Mailing Address
Mr. JERRAD LEE BENTON LMT, MMP
2430 TELLICHERRY DR. 300A
SAINT LOUIS, MO 63125-3108
Phone number: 314-600-6293
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