Organization
QUENTIN TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUENTIN RAYMONE CROCKETT (PRESIDENT)
(773) 886-2626
Entity
Organization
Contact information
Practice address
19712 CRESCENT AVE, LYNWOOD, IL 60411-1460
(773) 886-2626
Mailing address
19712 CRESCENT AVE, LYNWOOD, IL 60411-1460
(773) 886-2626
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
050473793
GA
Other
Enumeration date
09/30/2016
Last updated
09/30/2016
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