The holder whose full name is Tang, Benjamin Banchong,come from Crown Point IN,hold the CSR-Physician license(NO.01033529B) which status is Active.
| Name | Tang, Benjamin Banchong |
|---|---|
| License Number | 01033529B |
| License Type | CSR-Physician |
| License Status | Active |
| City | Crown Point |
| State | IN |