Individual
LAQUINTA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
930 BROOKDALE ST, MARTINSVILLE, VA 24112-3105
(276) 732-4852
(276) 632-9456
Mailing address
PO BOX 3324, MARTINSVILLE, VA 24115-3324
(276) 732-4852
(276) 632-9456
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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