OTHA MOORE

SOUTHFIELD, MI
NPI1275902132
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy302F00000X Exclusive Provider Organization
(Licence: MI  7153185)
Enumeration Date2015-09-22
Last Update Date2015-09-22
Business Address
Mr. OTHA MOORE
18430 WESTHAMPTON
SOUTHFIELD, MI 48075
Phone number: 313-844-1496
Mailing Address
Mr. OTHA MOORE
18430 WESTHAMPTON AVE
SOUTHFIELD, MI 48075-4116
Phone number: 313-844-1496
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