Individual
MONIQUE FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
36 RAILROAD AVE, KINGSTREE, SC 29556-2435
(843) 354-7848
Mailing address
PO BOX 931, KINGSTREE, SC 29556-0931
(843) 354-7848
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
P26038
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-4484187
—
SC
Enumeration date
12/17/2014
Last updated
12/17/2014
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