Individual
JODIE L FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 N 3RD AVE, YAKIMA, WA 98902-2632
(509) 965-5750
(509) 965-8257
Mailing address
208 N 3RD AVE, YAKIMA, WA 98902-2632
(509) 965-5750
(509) 965-8257
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00016698
WA
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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