Individual
MS. MARCIA LYNN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
519 LATHAM DR, LOWELL, AR 72745-8360
(479) 750-0125
(479) 750-0323
Mailing address
PO BOX 2089, LOWELL, AR 72745-2089
(479) 750-0125
(479) 750-0323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
97-24 E
AR
Other
Enumeration date
05/01/2009
Last updated
05/01/2009
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