Individual
KELLY VICTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2880 MINE AND MILL RD, LAKELAND, FL 33801-7008
(863) 500-2705
Mailing address
1128 N NEW YORK AVE, LAKELAND, FL 33805-4416
(863) 500-2705
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
V236500834590
FL
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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