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1356843379
FATIA A RUSSELL
FAYETTEVILLE, NC
NPI
1356843379
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
224P00000X Prosthetist
(Licence: NC 108796)
Enumeration Date
2018-03-06
Last Update Date
2019-08-31
Business Address
FATIA A RUSSELL
6245 LAKEHAVEN DR
FAYETTEVILLE, NC 28304-0610
Phone number: 910-479-6214
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Mailing Address
FATIA A RUSSELL
6245 LAKEHAVEN DR
FAYETTEVILLE, NC 28304-0610
Phone number: 910-479-6214
Copy
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