Individual
KELLY NAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
608 SW MARVIN BURNETT RD, LAKE CITY, FL 32025-4918
(386) 965-5197
Mailing address
25220 49TH RD, O BRIEN, FL 32071-4206
(352) 538-5230
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CWCM101389
FL
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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