Most Relevant Information
Provider Data
| NPI Number: | 1003393653 |
| Provider Name: | TERI FULLMER ABO |
| Entity Type: | Individual |
| Taxonomy Code: | 156FX1800X |
| Specialty: | Technician/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/26/2018 |
| Last Updated: | 07/26/2018 |
Provider Practice Location
7447 W EMERALD ST STE 105
BOISE
ID
837045003
Practice Location Phone/Fax
| Phone: | 2083221642 |
| Fax: | 2083784179 |
Provider Mailing Location
7447 W EMERALD ST STE 105
BOISE
ID
837045003
Provider Mailing Phone/Fax
| Phone: | 2083221642 |
| Fax: |