Individual
TONI LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3215 STONEBRIDGE CT, APT. 9, PORTAGE, MI 49024-8000
(770) 557-9213
Mailing address
3215 STONEBRIDGE CT, APT. 9, PORTAGE, MI 49024-8000
(770) 557-9213
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6401015501
MI
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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