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1528437597
KELLY JOAN KOUSTAS
DETROIT, MI
NPI
1528437597
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: MI 4703110676)
Enumeration Date
2015-09-21
Last Update Date
2015-09-21
Business Address
-- KELLY JOAN KOUSTAS
751 E GRAND BLVD
DETROIT, MI 48207-2529
Phone number: 313-995-0523
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Mailing Address
-- KELLY JOAN KOUSTAS
24616 NOTRE DAME
DEARBORN, MI 48124
Phone number: 313-995-0523
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