Individual
BENJAMIN ALEXANDER BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
207 63RD ST, ATHLETICO, WILLOW BROOK, IL 60527-2147
(630) 230-0900
Mailing address
220 LINCOLN OAKS DR, APT. 1413, WILLOW BROOK, IL 60527-3271
(630) 768-8556
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96002214
IL
Other
Enumeration date
12/15/2005
Last updated
07/08/2007
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