Individual
SHANE R FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
75-5699 ALII DR STE E, KAILUA KONA, HI 96740-3112
(443) 226-4939
Mailing address
75-5699 ALII DR STE E, KAILUA KONA, HI 96740-3112
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/13/2016
Last updated
06/14/2016
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