Individual
MS. KELLY BOLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6686 CAMPBELL ST, TAYLOR, MI 48180-1802
(313) 268-3348
Mailing address
14683 SHENANDOAH DR, RIVERVIEW, MI 48193-7728
(313) 268-3348
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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