Diana Fuller,micou
NPI #1205348554 in Kosciusko, Mississippi
Provider Information
- NPI Number
- 1205348554
- Entity Type
- Individual
- Name
- Diana Fuller,micou
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Voluntary or Charitable
- Enumeration Date
- Oct 26, 2017
- Last Updated
- Oct 26, 2017
Practice Location
- Address
- 825 JAMES H MEREDITH ST
- City
- Kosciusko
- State
- Mississippi
- ZIP Code
- 39090-3161
- Phone
- (662) 289-3699
Specialties & Taxonomy Codes
| Specialty |
|---|
| Voluntary or Charitable |
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