Individual
MS. KELLIE P VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT S.C.#4771
Contact information
Practice address
275 WILDAZALEA LANE, MARIETTA, SC 29661
(864) 270-0205
(864) 836-8101
Mailing address
P.O. BOX 959, MARIETTA, SC 29661
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4771
SC
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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