Individual
KENYA FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
931 CENTRAL AVE, MATTESON, IL 60443-1542
(833) 534-2639
Mailing address
1041 MONTEREY CT, UNIVERSITY PARK, IL 60484-3236
(708) 664-1250
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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