JUSTIN BENTON DAUGHERTY

SAN DIEGO, CA
NPI1992100911
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1710I1002X Military Health Care Provider Independent Duty Corpsman
Enumeration Date2014-11-03
Last Update Date2014-11-03
Business Address
JUSTIN BENTON DAUGHERTY IDC
3124 SALMON ST
SAN DIEGO, CA 92124-3605
Phone number: 402-699-7774
Mailing Address
JUSTIN BENTON DAUGHERTY IDC
3124 SALMON ST
SAN DIEGO, CA 92124-3605
Phone number: 402-699-7774
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