Individual
BENJAMIN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
10164 GLENNON ST, SAN DIEGO, CA 92124-2914
(714) 234-6316
Mailing address
10164 GLENNON ST, SAN DIEGO, CA 92124-2914
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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