Most Relevant Information
Provider Data
| NPI Number: | 1003322116 |
| Provider Name: | KELLEY KOUNOVSKY |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/27/2017 |
| Last Updated: | 12/27/2017 |
Provider Practice Location
585 JEWETT RD
MASON
MI
488548729
Practice Location Phone/Fax
| Phone: | 5176765405 |
| Fax: |
Provider Mailing Location
585 JEWETT RD
MASON
MI
488548729
Provider Mailing Phone/Fax
| Phone: | 5187676540 |
| Fax: |