Individual
THERON BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 WEST FIRST STREET, ELMIRA, NY 14905
(607) 333-6322
Mailing address
900 WEST FIRST STREET, ELMIRA, NY 14905
(607) 333-6322
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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