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1154656338
DERRICK CORNELIUS FULLWOOD
CLINTON, NC
NPI
1154656338
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
251S00000X
Enumeration Date
2009-10-06
Last Update Date
2009-10-06
Business Address
Mr. DERRICK CORNELIUS FULLWOOD
4442 BONNETSVILLE RD
CLINTON, NC 28328-1001
Phone number: 919-673-6332
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Mailing Address
Mr. DERRICK CORNELIUS FULLWOOD
4337 LAKE RIDGE DR
RALEIGH, NC 27604-3469
Phone number: 919-673-6332
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