Individual
MRS. PHYLLIS H KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1855 E MAIN ST, SPARTANBURG, SC 29307-2309
(864) 583-9007
Mailing address
1855 E MAIN ST, SPARTANBURG, SC 29307-2309
(864) 583-9007
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
198
SC
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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