Individual
TINA MCKELLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19932 BLACKSTONE ST, DETROIT, MI 48219-1313
(313) 538-5170
Mailing address
19932 BLACKSTONE ST, DETROIT, MI 48219-1313
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
MI
Other
Enumeration date
05/21/2016
Last updated
05/21/2016
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