Individual
CONNIE FULBRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4805 16TH ST, LUBBOCK, TX 79416-5623
(806) 797-3660
Mailing address
4805 16TH ST, LUBBOCK, TX 79416-5623
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
117319
TX
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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