Provider First Line Business Practice Location Address:
20 EMERGENCY SERVICE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MARTINSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26155-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-455-5931
Provider Business Practice Location Address Fax Number:
304-455-2824
Provider Enumeration Date:
07/22/2005