MARK E PETTIS

LA PORTE, IN
NPI1982884524
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy172V00000X Community Health Worker
(Licence: IN  06003247A)
Enumeration Date2007-11-12
Last Update Date2008-08-25
Business Address
Mr. MARK E PETTIS PTA
203 STANLEY CT
LA PORTE, IN 46350-4159
Phone number: 219-362-2744
Mailing Address
Mr. MARK E PETTIS PTA
203 STANLEY CT
LA PORTE, IN 46350-4159
Phone number: 219-362-2744