| Doctor Name: | MOL KY |
| NPI Number: | 1063607646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | MD01101TL |
| Business Practice Address: | 333 Revolutionary Trail Fairfax, SC - 29827 |
| Business Phone Number: | 8036322533 |
| Business Fax Number: | |
| Mailing Address: | Po Box 990, 333 Revolutionary Trail FAIRFAX |
| State: | SC |
| Postal Code: | 29827 |
| Phone Number: | 8036322533 |
| Fax Number: | 8036322451 |
| NPI Enumeration Date: | 09/07/2007 |
| NPI Last Update Date: | 09/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD01101TL |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |