1568623544

Everything you always wanted to know about MR. LIGHT MARTIN but were afraid to ask.

MR. LIGHT MARTIN

You can also download the this 1568623544 data report as csv | excel | json | xml
Provider Prefix Provider Last Name Provider First Name
MR. LIGHT MARTIN
Gender:
Male
Enumeration date:
2008-06-22
Last update date:
2008-06-22
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
171W00000X Contractor none $$$$$$$$$ Y

Phone Numbers

Type Number
Mailing Address Telephone Number 3144693484
Practice Location Address Telephone Number 3144693484
Mailing Address Fax Number 3144693484
Practice Location Address Fax Number 3144693484

Addresses

Type Address City State Postal Country
Mailing Address 330 BRANCHPORT DR CHESTERFIELD MO 63017 MO
Practice Location Address 330 BRANCHPORT DR CHESTERFIELD MO 63017 MO