Individual
CARL FULLER II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
88 RIVERBROOK RD, LUMBERTON, NC 28358-8666
(910) 536-9721
Mailing address
88 RIVERBROOK RD, LUMBERTON, NC 28358-8666
(910) 536-9721
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
A5070
NC
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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