Individual
EDSEL FULLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
207 OVERSTREET AVE, LONGWOOD, FL 32750-5428
(321) 295-7678
(321) 295-7678
Mailing address
207 OVERSTREET AVE, LONGWOOD, FL 32750-5428
(321) 295-7678
(321) 295-7678
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT 25414
FL
Other
Enumeration date
11/26/2016
Last updated
11/26/2016
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