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1982884524
MARK E PETTIS
LA PORTE, IN
NPI
1982884524
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172V00000X Community Health Worker
(Licence: IN 06003247A)
Enumeration Date
2007-11-12
Last Update Date
2008-08-25
Business Address
Mr. MARK E PETTIS PTA
203 STANLEY CT
LA PORTE, IN 46350-4159
Phone number: 219-362-2744
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Mailing Address
Mr. MARK E PETTIS PTA
203 STANLEY CT
LA PORTE, IN 46350-4159
Phone number: 219-362-2744
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