Most Relevant Information
Provider Data
| NPI Number: | 1003529330 |
| Provider Name: | TAWANNA Q KING |
| Entity Type: | Individual |
| Taxonomy Code: | 174200000X |
| Specialty: | Meals |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/02/2023 |
| Last Updated: | 01/12/2023 |
Provider Practice Location
18714 FORRER ST
DETROIT
MI
482352911
Practice Location Phone/Fax
| Phone: | 3136947770 |
| Fax: |
Provider Mailing Location
18714 FORRER ST
DETROIT
MI
482352911
Provider Mailing Phone/Fax
| Phone: | 3136947770 |
| Fax: |