Individual
MR. BENJAMIN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
314 SILTSTONE RDG, BRANDON, MS 39047-6377
(601) 397-8767
Mailing address
314 SILTSTONE RDG, BRANDON, MS 39047-6377
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0487
MS
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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