Provider First Line Business Practice Location Address:
RT. 10 THREE MILE CURVE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007