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1639636855
LATESA RENAE THOMAS
DETROIT, MI
NPI
1639636855
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Former Name
LATESA RENAE ENGRAM
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
372600000X Adult Companion
(Licence: MI 230109450998)
Enumeration Date
2019-02-24
Last Update Date
2019-08-26
Business Address
LATESA RENAE THOMAS C.N.A
11611 GRAYTON ST
DETROIT, MI 48224-1643
Phone number: 313-556-4769
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Mailing Address
LATESA RENAE THOMAS C.N.A
11611 GRAYTON ST
DETROIT, MI 48224-1643
Phone number: 313-556-4769
Copy
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