Individual
LATASHA BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
313 OLIVE BRANCH BLVD, GRIFTON, NC 28530-8584
(252) 531-3100
Mailing address
PO BOX 31032, GREENVILLE, NC 27833-1032
(252) 414-0999
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
25441176
NC
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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