Organization
VIVIAN L MARTIN
Active
Other names
Parkway Shoe Repair Service
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN LEA MARTIN (OWNER)
(618) 242-4442
Entity
Organization
Contact information
Practice address
1024 JORDAN ST, MOUNT VERNON, IL 62864-4231
(618) 242-4442
(618) 242-3942
Mailing address
1024 JORDAN ST, MOUNT VERNON, IL 62864-4231
(618) 242-4442
(618) 242-3942
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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