Individual
ADRIANNE MARIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
2810 E EMPIRE ST, BLOOMINGTON, IL 61704-4201
(773) 937-7878
Mailing address
PO BOX 702, DANVERS, IL 61732-0702
(773) 937-7878
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.009183
IL
Other
Enumeration date
05/18/2009
Last updated
05/18/2009
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