Individual
AUSTYN LYNNELL BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23225 THORNCLIFFE ST, SOUTHFIELD, MI 48033-6559
(586) 917-2338
Mailing address
23225 THORNCLIFFE ST, SOUTHFIELD, MI 48033-6559
(586) 917-2338
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
B460084564641
MI
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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