JACK G. FULLER

LOS ANGELES, CA
NPI1376596668
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: CA  PA12536)
Enumeration Date2006-05-18
Last Update Date2007-07-09
Business Address
Mr. JACK G. FULLER PA-C
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017-2395
Phone number: 213-977-2423
Mailing Address
Mr. JACK G. FULLER PA-C
2550 NORTHHOLLYWOOD WAY SUITE 209
BURBANK, CA 91505-5019
Phone number: 818-557-0135
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