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1497154660
ANNETTE FULTZ
IDAHO FALLS, ID
NPI
1497154660
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID 10156-818)
Enumeration Date
2014-08-13
Last Update Date
2014-08-13
Business Address
-- ANNETTE FULTZ CADC
2275 W BROADWAY ST
IDAHO FALLS, ID 83402-2902
Phone number: 208-524-7400
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Mailing Address
-- ANNETTE FULTZ CADC
2275 W BROADWAY ST
IDAHO FALLS, ID 83402-2902
Phone number:
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