Individual
LATARIUS OLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
607 MOONLIGHT CT, MONTGOMERY, AL 36117-3974
(334) 224-4903
Mailing address
607 MOONLIGHT CT, MONTGOMERY, AL 36117-3974
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S12731
AL
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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