Individual
AFFIE ANN BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26797 ROSELAND RD, ELKHART, IN 46514-6122
(574) 215-6628
Mailing address
26797 ROSELAND RD, ELKHART, IN 46514-6122
(574) 215-6628
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
597RBZ
IN
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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