Individual
GLEN WAYNE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
218 N LOGAN AVE, DANVILLE, IL 61832-5655
(217) 431-0240
Mailing address
108 LAKESIDE DR, DANVILLE, IL 61832-1317
(217) 497-0444
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
B-0014
IL
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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