Organization
FULFILLING LIFE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DI'ARA WOODS PA-C, CLC (CEO)
(314) 749-8906
Entity
Organization
Contact information
Practice address
3 CLUB CENTRE CT STE B1, EDWARDSVILLE, IL 62025-3519
(618) 699-4402
(618) 590-8199
Mailing address
403 GLEN CARBON RD, GLEN CARBON, IL 62034-2965
(314) 749-8906
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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