Individual
MR. VICTOR RAY FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NA
Contact information
Practice address
5720 79TH ST, LUBBOCK, TX 79424-2624
(806) 698-9105
Mailing address
5720 79TH ST, LUBBOCK, TX 79424-2624
(806) 698-9105
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
117087
TX
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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