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1124015102
CHUCK B FULLER
TWIN FALLS, ID
NPI
1124015102
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: ID PA-499)
Enumeration Date
2005-10-04
Last Update Date
2008-01-10
Business Address
-- CHUCK B FULLER PA-C
660 SHOSHONE ST E SUITE 130
TWIN FALLS, ID 83301-6110
Phone number: 208-732-3400
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Mailing Address
-- CHUCK B FULLER PA-C
660 SHOSHONE ST E SUITE 130
TWIN FALLS, ID 83301-6110
Phone number: 208-732-3400
Copy
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