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Individual

CAMILLE EVON FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
29101 HOSPITAL RD, LAKE ARROWHEAD, CA 92352-9706
(909) 336-3651
Mailing address
PO BOX 1703, CRESTLINE, CA 92325-1703

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
297745
CA

Other

Enumeration date
11/18/2019
Last updated
11/18/2019
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