Individual
LATONYA WALLACE-HARDIMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, MSA
Contact information
Practice address
5830 CONNER ST, DETROIT, MI 48213-3458
(313) 924-1456
(313) 636-2290
Mailing address
162 SAND BAR LN, DETROIT, MI 48214-8034
(313) 715-7170
(313) 636-2290
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
04/06/2018
Last updated
12/17/2020
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