Individual
LAKILA TIERRA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26431 PRINCETON ST, INKSTER, MI 48141-2444
(313) 207-8034
Mailing address
26431 PRINCETON ST, INKSTER, MI 48141-2444
(313) 207-8034
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
F460488793741
MI
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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