DERRICK CORNELIUS FULLWOOD

CLINTON, NC
NPI1154656338
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy251S00000X Community/Behavioral Health
Enumeration Date2009-10-06
Last Update Date2009-10-06
Business Address
Mr. DERRICK CORNELIUS FULLWOOD
4442 BONNETSVILLE RD
CLINTON, NC 28328-1001
Phone number: 919-673-6332
Mailing Address
Mr. DERRICK CORNELIUS FULLWOOD
4337 LAKE RIDGE DR
RALEIGH, NC 27604-3469
Phone number: 919-673-6332
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