Individual
MARK MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3041 S CHARLTON PARK RD, HASTINGS, MI 49058-8806
(269) 945-0956
Mailing address
3041 S CHARLTON PARK RD, HASTINGS, MI 49058-8806
(269) 945-0956
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
M635585161310
MI
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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