Individual
BABOONIE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
732 W MELVINA ST, MILWAUKEE, WI 53206-3342
(414) 915-8189
Mailing address
732 W MELVINA ST, MILWAUKEE, WI 53206-3342
(414) 915-8189
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/03/2014
Last updated
01/03/2014
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