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Individual

EBAY L FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4403 E 143RD ST, CLEVELAND, OH 44128-2311
(216) 894-1548
Mailing address
16705 MAPLE HEIGHTS BLVD, MAPLE HEIGHTS, OH 44137-2642
(216) 894-1548

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RU776904
OH

Other

Enumeration date
04/11/2024
Last updated
04/11/2024
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