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1457879470
KETRA FULLER
SHREVEPORT, LA
NPI
1457879470
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2017-08-30
Last Update Date
2022-07-21
Business Address
KETRA FULLER
4718 HEARNE AVE
SHREVEPORT, LA 71108
Phone number: 318-828-1521
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Mailing Address
KETRA FULLER
4718 HEARNE AVE
SHREVEPORT, LA 71108-2703
Phone number: 318-828-1521
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