Individual
BENJAMIN J MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7330 SAN PEDRO, SUITE 130, SAN ANTONIO, TX 78216-6235
(210) 349-0550
Mailing address
8311 COPPERSIDE, CONVERSE, TX 78109-3901
(210) 724-0968
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
TX
Other
Enumeration date
07/23/2007
Last updated
07/23/2007
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