Individual
ANDRE LATELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27003 PLYMOUTH RD, REDFORD, MI 48239-2343
(313) 744-7055
Mailing address
PO BOX 4388, DETROIT, MI 48204-0388
(313) 516-5536
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
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