Individual
TIERA TAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1957 MT. ZION RD, GROVE HILL, AL 36451-0023
(251) 769-3220
Mailing address
PO BOX 23, GROVE HILL, AL 36451-0023
(251) 769-3220
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
7667724
AL
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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