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Diana Fuller,micou
Voluntary or Charitable Agency in Kosciusko, Mississippi
NPI 1205348554

Diana Fuller,micou is a Voluntary or Charitable Agency based in Kosciusko, MS. Diana Fuller,micou practices in Kosciusko, MS. The NPI Number for Diana Fuller,micou is 1205348554 and holds a License No. (Mississippi).

The current practice location address for Diana Fuller,micou is 825 James H Meredith St, Kosciusko, MS and can be reached out via phone at 662-289-3699.

Location: 825 James H Meredith St, Kosciusko, MS, 39090-3161
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205348554
Provider Name
Diana Fuller,micou
Credential
Provider Entity Type
Individual
Gender
Female
Address
825 James H Meredith St, Kosciusko, MS, 39090-3161
Phone Number
662-289-3699
Fax Number
Provider Enumeration Date
10/26/2017
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
825 James H Meredith St
City
Kosciusko
State
Mississippi
Zip
39090-3161
Phone Number
662-289-3699
Fax Number
person
Provider Business Mailing Address Details
Address
825 James H Meredith St
City
Kosciusko
State
Mississippi
Zip
39090-3161
Phone Number
662-289-3699
Fax Number
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Voluntary or Charitable
Speciality
-
Taxonomy
251V00000X
License No.
()
Definition
Definition to come...
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