Individual
KIMBERLY FULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
677 E. MAIN ST./STE A, CENTREVILLE, MI 49032-3071
(269) 467-1000
Mailing address
677 E. MAIN ST./STE A, CENTREVILLE, MI 49032-3071
(269) 467-1000
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/04/2016
Last updated
08/09/2016
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