Individual
BENJAMIN FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10318 GLENBURN LN, CHARLOTTE, NC 28278-6005
(704) 906-8095
Mailing address
10318 GLENBURN LN, CHARLOTTE, NC 28278-6005
(704) 906-8095
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1814
NC
Other
Enumeration date
12/05/2013
Last updated
12/05/2013
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