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Individual

MS. LAVENITA MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
432 HOXIE AVE, CALUMET CITY, IL 60409-2315
(708) 674-3113
Mailing address
432 HOXIE AVE, CALUMET CITY, IL 60409-2315
(708) 674-3113

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary

Other

Enumeration date
05/13/2013
Last updated
05/13/2013
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