Individual
MISS KISHA NICOLE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1695 GRAVES RD APT 1801, NORCROSS, GA 30093-5915
(770) 294-3733
Mailing address
1695 GRAVES RD APT 1801, NORCROSS, GA 30093-5915
(770) 294-3733
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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