Individual
LIDIA DE LA TORRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12370 FORDLINE ST, SOUTHGATE, MI 48195-2304
(313) 350-1202
Mailing address
12370 FORDLINE ST, SOUTHGATE, MI 48195-2304
(313) 350-1202
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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