Individual
GARY POTVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5619 LOON DR, BIG LAKE, MN 55309-8984
(612) 598-6626
Mailing address
5619 LOON DR, BIG LAKE, MN 55309-8984
(612) 598-6626
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
MN
Other
Enumeration date
11/03/2008
Last updated
11/03/2008
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