Individual
JOHN HENRY MARTIN LICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15244 W WATSON LN, SURPRISE, AZ 85379-7040
(623) 227-9697
Mailing address
15244 W WATSON LN, SURPRISE, AZ 85379-7040
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11496H
AZ
Other
Enumeration date
06/19/2020
Last updated
06/19/2020
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