Individual
MS. KIM D BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
(313) 345-4315
Mailing address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
(313) 345-4315
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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