Provider First Line Business Practice Location Address:
61 S KANAWHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-3160
Provider Business Practice Location Address Fax Number:
304-472-5729
Provider Enumeration Date:
10/11/2006